Provider Demographics
NPI:1508492133
Name:MUNSON HEALTHCARE GRAYLING
Entity Type:Organization
Organization Name:MUNSON HEALTHCARE GRAYLING
Other - Org Name:MILLTOWN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO EAST REGION
Authorized Official - Prefix:
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:O
Authorized Official - Last Name:KORTH-WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-348-0720
Mailing Address - Street 1:1200 W NORTH DOWN RIVER RD STE C
Mailing Address - Street 2:
Mailing Address - City:GRAYLING
Mailing Address - State:MI
Mailing Address - Zip Code:49738-8024
Mailing Address - Country:US
Mailing Address - Phone:231-935-6455
Mailing Address - Fax:231-935-6646
Practice Address - Street 1:1200 W NORTH DOWN RIVER RD STE C
Practice Address - Street 2:
Practice Address - City:GRAYLING
Practice Address - State:MI
Practice Address - Zip Code:49738-8024
Practice Address - Country:US
Practice Address - Phone:231-935-6455
Practice Address - Fax:231-935-6646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-16
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty