Provider Demographics
NPI:1164508891
Name:MUNSON HEALTHCARE CHARLEVOIX HOSPITAL
Entity Type:Organization
Organization Name:MUNSON HEALTHCARE CHARLEVOIX HOSPITAL
Other - Org Name:CHARLEVOIX AREA HOSPITAL SWING BED
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILHELM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-547-8511
Mailing Address - Street 1:14700 LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLEVOIX
Mailing Address - State:MI
Mailing Address - Zip Code:49720-1931
Mailing Address - Country:US
Mailing Address - Phone:231-547-4024
Mailing Address - Fax:231-547-8088
Practice Address - Street 1:14700 LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:CHARLEVOIX
Practice Address - State:MI
Practice Address - Zip Code:49720-1931
Practice Address - Country:US
Practice Address - Phone:231-547-4024
Practice Address - Fax:231-547-8088
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MUNSON HEALTHCARE CHARLEVOIX HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-27
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5170308Medicaid
MI23Z322Medicare Oscar/Certification