MEDICARE: CARSON CITY HOSPITAL

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	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1528316932
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARSON CITY HOSPITAL

Provider Business Mailing Address
First Line	:	406 E ELM ST
Second Line	:
City	:	CARSON CITY
State	:	MI
Zip	:	48811-9693
Country	:	US
Telephone Number	:	989-584-3971
Fax Number	:	989-584-6734

Provider Business Practice Location Address
First Line	:	639 E MAIN ST
Second Line	:
City	:	CARSON CITY
State	:	MI
Zip	:	48811-9795
Country	:	US
Telephone Number	:	989-584-3107
Fax Number	:	989-584-6118

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MATTHEW J THOMPSON
Credential	:
Telephone Number	:	989-584-3971

Provider Enumeration Date	:	08/16/2012
Last Update Date	:	12/06/2012

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Directions to “CARSON CITY HOSPITAL ” Practice Location

Language	Start Address	Practice Location

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