Provider Demographics
NPI:1598477408
Name:MUNSON HEALTHCARE CADILLAC
Entity Type:Organization
Organization Name:MUNSON HEALTHCARE CADILLAC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:231-935-9283
Mailing Address - Street 1:803 LYNN ST
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-2336
Mailing Address - Country:US
Mailing Address - Phone:231-876-6180
Mailing Address - Fax:231-876-6080
Practice Address - Street 1:803 LYNN ST
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-2336
Practice Address - Country:US
Practice Address - Phone:231-876-6180
Practice Address - Fax:231-876-6080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-22
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine