Healthcare Provider Details

I. General information

NPI: 1922488436
Provider Name (Legal Business Name): CHARLEVOIX AREA HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2015
Last Update Date: 06/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14700 LAKE SHORE DR
CHARLEVOIX MI
49720-1931
US

IV. Provider business mailing address

14700 LAKE SHORE DR
CHARLEVOIX MI
49720-1931
US

V. Phone/Fax

Practice location:
  • Phone: 231-547-4024
  • Fax: 231-547-8088
Mailing address:
  • Phone: 231-547-4024
  • Fax: 231-547-8088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateMI

VIII. Authorized Official

Name: CHRISTINE WILHELM
Title or Position: CHIEF OPERATIONS OFFICER
Credential:
Phone: 231-547-8511