Provider Demographics
NPI:1629079389
Name:SCHOOLCRAFT MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:SCHOOLCRAFT MEMORIAL HOSPITAL
Other - Org Name:SCHOOLCRAFT MEMORIAL HOSPITAL RURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BERTAPELLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-341-3221
Mailing Address - Street 1:7870W US HIGHWAY 2
Mailing Address - Street 2:
Mailing Address - City:MANISTIQUE
Mailing Address - State:MI
Mailing Address - Zip Code:49854-8992
Mailing Address - Country:US
Mailing Address - Phone:906-341-2153
Mailing Address - Fax:906-341-3299
Practice Address - Street 1:7870W US HIGHWAY 2
Practice Address - Street 2:
Practice Address - City:MANISTIQUE
Practice Address - State:MI
Practice Address - Zip Code:49854-8992
Practice Address - Country:US
Practice Address - Phone:906-341-2153
Practice Address - Fax:906-341-3299
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SCHOOLCRAFT MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-03
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0G71004OtherRHC BCBS
MI0G71004OtherRHC BCBS
MI74-2157055OtherSMH TAX ID NUMBER
MI238588Medicare Oscar/Certification