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General NPI Number Information
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NPI Number | 1639196199
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Entity Type | Organization
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Legal Business Name | COMMUNITY MEMORIAL HOSPITAL
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 12/08/2008
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Provider Practice Location Address
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Address Line | 6135 CRESSY ST
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City | INDIAN RIVER
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State | MI
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Zip | 49749
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Country | US
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Telephone | 231-238-8908
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Fax | 231-238-4419
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Provider Business Mailing Address
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Address Line | PO BOX 419
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City | CHEBOYGAN
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State | MI
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Zip | 49721-0419
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Country | US
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Telephone | 231-627-1438
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Fax | 231-627-1471
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Authorized Official
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Title or Position | VICE PRESIDENT/FINANCE
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Name | MRS. HOLLY CAMPA
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Credential |
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Telephone | 231-627-1203
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine 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 | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State | MI
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