Provider Demographics
NPI:1346260692
Name:MUNSON HEALTHCARE CHARLEVOIX HOSPITAL
Entity Type:Organization
Organization Name:MUNSON HEALTHCARE CHARLEVOIX HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:HEPLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-935-5000
Mailing Address - Street 1:14700 LAKE SHORE DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHARLEVOIX
Mailing Address - State:MI
Mailing Address - Zip Code:49720-1939
Mailing Address - Country:US
Mailing Address - Phone:231-547-4024
Mailing Address - Fax:231-547-8088
Practice Address - Street 1:14700 LAKE SHORE DRIVE
Practice Address - Street 2:
Practice Address - City:CHARLEVOIX
Practice Address - State:MI
Practice Address - Zip Code:49720-1939
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
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-20
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI150021282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1001019OtherNORTHERN HEALTH PLAN
MI134141100OtherCOMP CARRIER US POSTAL SV
MI00095OtherBLUE CARE NETWORK
MI00095OtherBLUE CROSS HOSP
MI5170308Medicaid
MI1557598Medicaid
MI4286OtherPRIORITY HEALTH
MI1001019OtherNORTHERN HEALTH PLAN
MI00095OtherBLUE CARE NETWORK
MI=========OtherFIRST HEALTH HOSP
MI=========000OtherCOMMUNITY CHOICE
MI4286OtherPRIORITY HEALTH
MI=========001OtherTRICARE