Healthcare Provider Details

I. General information

NPI: 1285867838
Provider Name (Legal Business Name): MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2009
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3040 BOURN ST
LEWISTON MI
49756
US

IV. Provider business mailing address

829 N CENTER AVE
GAYLORD MI
49735-1595
US

V. Phone/Fax

Practice location:
  • Phone: 989-786-4877
  • Fax: 989-786-2187
Mailing address:
  • Phone: 989-731-2100
  • Fax: 989-731-7929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number238620
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BONNIE KRUSZKA
Title or Position: COO MUNSON PHYSICIAN NETWORK
Credential:
Phone: 231-935-4995