=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093038754
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EMMET COUNTY MEDICAL CARE FACILITY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2010
-----------------------------------------------------
Last Update Date | 03/10/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 750 E MAIN ST
-----------------------------------------------------
City | HARBOR SPRINGS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49740-1548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-526-2161
-----------------------------------------------------
Fax | 231-526-5252
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 750 E MAIN ST
-----------------------------------------------------
City | HARBOR SPRINGS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49740-1548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-526-2161
-----------------------------------------------------
Fax | 231-526-5252
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING
-----------------------------------------------------
Name | SHERRY L BECKER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 231-526-4403
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 248510
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 248510
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 248510
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 248510
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------