Provider Demographics
NPI:1114288735
Name:NORTHERN MICHIGAN REGIONAL HOSPITAL
Entity Type:Organization
Organization Name:NORTHERN MICHIGAN REGIONAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZECHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-487-4011
Mailing Address - Street 1:416 CONNABLE AVE
Mailing Address - Street 2:ADMINISTRATION - CEO / (RURAL HEALTH CLINIC)
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2212
Mailing Address - Country:US
Mailing Address - Phone:231-487-7684
Mailing Address - Fax:231-487-7721
Practice Address - Street 1:6135 CRESSY ST
Practice Address - Street 2:POST OFFICE BOX 548
Practice Address - City:INDIAN RIVER
Practice Address - State:MI
Practice Address - Zip Code:49749-5151
Practice Address - Country:US
Practice Address - Phone:231-238-8908
Practice Address - Fax:231-238-4419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-30
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
238547Medicare PIN