Healthcare Provider Details

I. General information

NPI: 1407949191
Provider Name (Legal Business Name): MUNSON HEALTHCARE MANISTEE HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 E PARKDALE AVE
MANISTEE MI
49660-9785
US

IV. Provider business mailing address

1465 E PARKDALE AVE
MANISTEE MI
49660-9785
US

V. Phone/Fax

Practice location:
  • Phone: 231-398-1000
  • Fax: 231-398-0364
Mailing address:
  • Phone: 231-398-1000
  • Fax: 231-398-0364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number
License Number StateMI
# 6
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number510020
License Number StateMI

VIII. Authorized Official

Name: KIRSTEN BETHANY KORTH-WHITE
Title or Position: PRESIDENT/CEO SOUTH REGION
Credential:
Phone: 989-348-0720