Healthcare Provider Details

I. General information

NPI: 1649457771
Provider Name (Legal Business Name): MUNSON HEALTHCARE MANISTEE HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2008
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 E PARKDALE AVE
MANISTEE MI
49660-9709
US

IV. Provider business mailing address

375 RIVER ST
MANISTEE MI
49660-2729
US

V. Phone/Fax

Practice location:
  • Phone: 231-398-1000
  • Fax:
Mailing address:
  • Phone: 231-398-1950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: ELLEN O SMITH
Title or Position: CFO
Credential:
Phone: 231-935-6512