Healthcare Provider Details

I. General information

NPI: 1811285604
Provider Name (Legal Business Name): KALKASKA MEMORIAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2011
Last Update Date: 07/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 S CORAL ST
KALKASKA MI
49646-2503
US

IV. Provider business mailing address

419 S CORAL ST
KALKASKA MI
49646-2503
US

V. Phone/Fax

Practice location:
  • Phone: 231-258-7500
  • Fax: 231-258-7527
Mailing address:
  • Phone: 231-258-7500
  • Fax: 231-258-7527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number400020
License Number StateMI

VIII. Authorized Official

Name: JAMES AUSTIN
Title or Position: CEO
Credential:
Phone: 231-258-7501