Healthcare Provider Details

I. General information

NPI: 1932363454
Provider Name (Legal Business Name): MUNSON MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2008
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 6TH ST
TRAVERSE CITY MI
49684-2345
US

IV. Provider business mailing address

PO BOX 1131
TRAVERSE CITY MI
49685-1131
US

V. Phone/Fax

Practice location:
  • Phone: 231-935-5000
  • Fax:
Mailing address:
  • Phone: 231-935-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number StateMI

VIII. Authorized Official

Name: KATHLEEN LARAIA
Title or Position: PRESIDENT/CEO MMC
Credential:
Phone: 231-392-8410