Healthcare Provider Details

I. General information

NPI: 1831295708
Provider Name (Legal Business Name): CARSON CITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 10/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 E ELM ST
CARSON CITY MI
48811-9693
US

IV. Provider business mailing address

P.O. BOX 879 406 E. ELM STREET
CARSON CITY MI
48811-0879
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number5301002431
License Number StateMI

VIII. Authorized Official

Name: MATTHEW THOMPSON
Title or Position: PRESIDENT
Credential:
Phone: 989-584-3971