=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336879618
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MUNSON HEALTHCARE GRAYLING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2022
-----------------------------------------------------
Last Update Date | 10/02/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1250 E MICHIGAN AVE
-----------------------------------------------------
City | GRAYLING
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49738-7074
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-348-0550
-----------------------------------------------------
Fax | 989-348-0473
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1250 E MICHIGAN AVE
-----------------------------------------------------
City | GRAYLING
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49738-7074
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-348-0550
-----------------------------------------------------
Fax | 989-348-0473
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COO MUNSON PHYSICIAN NETWORK
-----------------------------------------------------
Name | BONNIE KRUSZKA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 231-935-4995
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208800000X
-----------------------------------------------------
Taxonomy Name | Urology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #7
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #8
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------