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General NPI Number Information
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NPI Number | 1427064054
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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 | 08/01/2006
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Last Update Date | 08/22/2018
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Provider Practice Location Address
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Address Line | 829 N CENTER AVE SUITE 160
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City | GAYLORD
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State | MI
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Zip | 49735
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Country | US
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Telephone | 989-732-7131
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Fax |
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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 | 989-731-7708
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Fax | 989-731-7929
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Authorized Official
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Title or Position | CHIEF REVENUE OFFICER
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Name | MR. KEVIN WAHR
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Credential | CRO
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Telephone | 989-731-7777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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