Healthcare Provider Details

I. General information

NPI: 1043428931
Provider Name (Legal Business Name): CARSON CITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 E ELM ST
CARSON CITY MI
48811-9693
US

IV. Provider business mailing address

406 E ELM ST PO BOX 879
CARSON CITY MI
48811-9693
US

V. Phone/Fax

Practice location:
  • Phone: 989-584-3131
  • Fax: 989-584-3729
Mailing address:
  • Phone: 989-584-3131
  • Fax: 989-584-3729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MISTY GUNTER RUSSIAN
Title or Position: REGIONAL MANAGER, PROVIDER ENROLLME
Credential:
Phone: 517-253-6308