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General NPI Number Information
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NPI Number | 1285867838
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Entity Type | Organization
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Legal Business Name | MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL
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Dates
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Enumeration Date | 08/31/2009
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Last Update Date | 10/04/2024
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Provider Practice Location Address
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Address Line | 3040 BOURN ST
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City | LEWISTON
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State | MI
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Zip | 49756
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Country | US
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Telephone | 989-786-4877
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Fax | 989-786-2187
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Provider Business Mailing Address
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Address Line | 829 N CENTER AVE
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City | GAYLORD
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State | MI
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Zip | 49735-1595
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Country | US
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Telephone | 989-731-2100
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Fax | 989-731-7929
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Authorized Official
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Title or Position | COO MUNSON PHYSICIAN NETWORK
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Name | BONNIE KRUSZKA
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Credential |
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Telephone | 231-935-4995
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 282NR1301X
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Taxonomy Name | Rural Acute Care Hospital
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License Number | 238620
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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