Healthcare Provider Details

I. General information

NPI: 1609073709
Provider Name (Legal Business Name): MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9099 E LANSING RD STE B
DURAND MI
48429-1083
US

IV. Provider business mailing address

113 E WILLIAMS ST
OWOSSO MI
48867-2360
US

V. Phone/Fax

Practice location:
  • Phone: 989-288-0400
  • Fax: 989-288-7862
Mailing address:
  • Phone: 989-725-6528
  • Fax: 989-723-9446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: JORRI M TREMAIN
Title or Position: CFO
Credential:
Phone: 989-729-4466