Healthcare Provider Details

I. General information

NPI: 1992074777
Provider Name (Legal Business Name): MUNSON HEALTHCARE CHARLEVOIX HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2011
Last Update Date: 03/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14734 PARK AVE
CHARLEVOIX MI
49720-1927
US

IV. Provider business mailing address

14734 PARK AVE
CHARLEVOIX MI
49720-1927
US

V. Phone/Fax

Practice location:
  • Phone: 231-547-6554
  • Fax: 231-547-1179
Mailing address:
  • Phone: 231-547-6554
  • Fax: 231-547-1179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK HEPLER
Title or Position: CFO
Credential:
Phone: 231-935-5000