MEDICARE: MUSKEGON COOPERATIVE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	900F17620	OTHER	MI	BC/BS OF MICHIGAN

General Provider Information

NPI Number	:	1336250026
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MUSKEGON COOPERATIVE, INC

Provider Business Mailing Address
First Line	:	499 W NORTON AVE
Second Line	:
City	:	MUSKEGON
State	:	MI
Zip	:	49444-3727
Country	:	US
Telephone Number	:	231-733-2685
Fax Number	:	231-737-1236

Provider Business Practice Location Address
First Line	:	499 W NORTON AVE
Second Line	:
City	:	MUSKEGON
State	:	MI
Zip	:	49444-3727
Country	:	US
Telephone Number	:	231-733-2685
Fax Number	:	231-737-1236

Authorized Official
Title or Position	:	GENERAL MANAGER
Name	:	SUSAN KAY PRESSLER
Credential	:
Telephone Number	:	231-733-2685

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	08/22/2020

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Directions to “MUSKEGON COOPERATIVE, INC ” Practice Location

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