Provider Demographics
NPI:1124415666
Name:INDIGO HOSPITAL MEDICINE - MANISTEE, PLC
Entity Type:Organization
Organization Name:INDIGO HOSPITAL MEDICINE - MANISTEE, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCMORROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-346-6807
Mailing Address - Street 1:10850 E TRAVERSE HWY
Mailing Address - Street 2:STE 4400
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-1364
Mailing Address - Country:US
Mailing Address - Phone:231-346-6800
Mailing Address - Fax:
Practice Address - Street 1:1400 E PARKDALE AVE
Practice Address - Street 2:
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-9776
Practice Address - Country:US
Practice Address - Phone:231-346-6807
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-22
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty