Provider Demographics
NPI:1487010609
Name:MUNSON HEALTHCARE MANISTEE HOSPITAL
Entity Type:Organization
Organization Name:MUNSON HEALTHCARE MANISTEE HOSPITAL
Other - Org Name:MUNSON HEALTHCARE - MANISTEE FAMILY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AMBULATORY CLINICS
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:O
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-935-7840
Mailing Address - Street 1:1391 E PARKDALE AVE
Mailing Address - Street 2:
Mailing Address - City:MANISTEE
Mailing Address - State:MI
Mailing Address - Zip Code:49660-9352
Mailing Address - Country:US
Mailing Address - Phone:231-398-1878
Mailing Address - Fax:231-398-1768
Practice Address - Street 1:1391 E PARKDALE AVE
Practice Address - Street 2:
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-9352
Practice Address - Country:US
Practice Address - Phone:231-398-1760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MUNSON HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-04
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health