Provider Demographics
NPI:1629260203
Name:MYMICHIGAN MEDICAL CENTER SAULT
Entity Type:Organization
Organization Name:MYMICHIGAN MEDICAL CENTER SAULT
Other - Org Name:WAR MEMORIAL BEHAVORIAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KALCHIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-635-4460
Mailing Address - Street 1:16523 S WATER TOWER DR
Mailing Address - Street 2:
Mailing Address - City:KINCHELOE
Mailing Address - State:MI
Mailing Address - Zip Code:49788-1592
Mailing Address - Country:US
Mailing Address - Phone:906-495-4351
Mailing Address - Fax:
Practice Address - Street 1:16523 S WATER TOWER DR
Practice Address - Street 2:
Practice Address - City:KINCHELOE
Practice Address - State:MI
Practice Address - Zip Code:49788-1592
Practice Address - Country:US
Practice Address - Phone:906-495-4351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHIPPEWA COUNTY WAR MEMORIAL HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-16
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI170020273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
23S239Medicare Oscar/Certification