Healthcare Provider Details

I. General information

NPI: 1629120415
Provider Name (Legal Business Name): MUNISING MEMORIAL HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 03/22/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 SAND POINT ROAD
MUNISING MI
49862-1406
US

IV. Provider business mailing address

1500 SAND POINT ROAD
MUNISING MI
49862-1406
US

V. Phone/Fax

Practice location:
  • Phone: 906-387-4338
  • Fax: 906-387-2825
Mailing address:
  • Phone: 906-387-4338
  • Fax: 906-387-2825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number1060000115
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: WENDY RAUTIO
Title or Position: CFO
Credential:
Phone: 906-387-4110