Healthcare Provider Details

I. General information

NPI: 1235789751
Provider Name (Legal Business Name): MUNSON HEALTHCARE GRAYLING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2019
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 S MOUNT TOM RD
MIO MI
48647-9518
US

IV. Provider business mailing address

1321 S MOUNT TOM RD
MIO MI
48647-9518
US

V. Phone/Fax

Practice location:
  • Phone: 989-275-1200
  • Fax: 989-275-1210
Mailing address:
  • Phone: 989-275-1200
  • Fax: 989-275-1210

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