Healthcare Provider Details

I. General information

NPI: 1558283150
Provider Name (Legal Business Name): MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N ROLAND ST
MC BAIN MI
49657-9683
US

IV. Provider business mailing address

1105 SIXTH ST
TRAVERSE CITY MI
49684-2345
US

V. Phone/Fax

Practice location:
  • Phone: 231-825-8101
  • Fax: 231-825-8104
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

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