Healthcare Provider Details

I. General information

NPI: 1386101566
Provider Name (Legal Business Name): THE MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2019
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 W M 21 STE 103
OVID MI
48866-9798
US

IV. Provider business mailing address

819 N SHIAWASSEE ST STE 105
OWOSSO MI
48867-1601
US

V. Phone/Fax

Practice location:
  • Phone: 989-862-4858
  • Fax: 989-862-5355
Mailing address:
  • Phone: 989-729-4781
  • Fax: 989-729-4971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JORRI M TREMAIN
Title or Position: CFO
Credential:
Phone: 989-729-4466