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NPI Code Detail

MEDICARE: MUNSON MEDICAL CENTER

MEDICARE: MUNSON MEDICAL CENTER
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
1104100000XSocial Worker

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1800B811370OTHERBLUE SHIELD
2800B811370OTHERBLUE CARE NETWORK

General Provider Information

NPI Number : 1386672665
Entity Type Code : Organization
Provider Name (Legal Business Name) : MUNSON MEDICAL CENTER
Provider Business Mailing Address
First Line : PO BOX 1131
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49685-1131
Country : US
Telephone Number : 231-935-5000
Fax Number :
Provider Business Practice Location Address
First Line : 4230 COPPER RIDGE DR
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49684-7256
Country : US
Telephone Number : 231-935-5000
Fax Number :
Authorized Official
Title or Position : COO MUNSON PHYSICIAN NETWORK
Name : BONNIE KRUSZKA
Credential :
Telephone Number : 231-935-4995
Provider Enumeration Date : 06/28/2006
Last Update Date : 10/04/2024

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