Healthcare Provider Details

I. General information

NPI: 1346481553
Provider Name (Legal Business Name): MERCY HOSPITAL GRAYLING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2009
Last Update Date: 02/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2585 W HOUGHTON LAKE DR
PRUDENVILLE MI
48651-9624
US

IV. Provider business mailing address

PO BOX 566
GRAYLING MI
49738-0566
US

V. Phone/Fax

Practice location:
  • Phone: 989-366-2900
  • Fax:
Mailing address:
  • Phone: 989-348-1040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE RIEMER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 989-348-5461