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General NPI Number Information
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NPI Number | 1710383351
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Entity Type | Organization
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Legal Business Name | MUNSON HEALTHCARE GRAYLING
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Dates
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Enumeration Date | 11/10/2014
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 234 LAKE ST
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City | ROSCOMMON
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State | MI
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Zip | 48653-9203
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Country | US
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Telephone | 989-275-1200
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Fax |
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Provider Business Mailing Address
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Address Line | 1105 SIXTH ST
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-2349
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Country | US
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Telephone | 231-935-5000
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Fax |
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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 | 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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