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General NPI Number Information
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NPI Number | 1801881461
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Entity Type | Organization
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Legal Business Name | GRAND TRAVERSE HEART INSTITUTE
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Dates
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Enumeration Date | 09/20/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1200 SIXTH ST SUITE 200
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-2369
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Country | US
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Telephone | 231-935-5800
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Fax | 231-935-5822
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Provider Business Mailing Address
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Address Line | PO BOX 1627 1200 SIXTH STREET #200
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City | TRAVERSE CITY
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State | MI
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Zip | 49685-1627
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Country | US
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Telephone | 231-935-5800
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Fax | 231-935-5822
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Authorized Official
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Title or Position | BILLING DIRECTOR
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Name | BONNIE L SUPINA
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Credential |
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Telephone | 231-935-5743
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State | MI
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