Healthcare Provider Details

I. General information

NPI: 1215273941
Provider Name (Legal Business Name): MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2012
Last Update Date: 12/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 N STATE RD
OWOSSO MI
48867-9075
US

IV. Provider business mailing address

826 W KING ST
OWOSSO MI
48867-2120
US

V. Phone/Fax

Practice location:
  • Phone: 989-743-3415
  • Fax: 989-743-6180
Mailing address:
  • Phone: 989-723-5211
  • 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: JOYCE A BREMER
Title or Position: DIRECTOR OF PRACTICE MANAGEMENT
Credential: CPC
Phone: 989-729-4528