Provider Demographics
NPI: | 1659490803 |
---|---|
Name: | CARSON CITY HOSPITAL |
Entity Type: | Organization |
Organization Name: | CARSON CITY HOSPITAL |
Other - Org Name: | MSG BCBS GROUP PSYCHIATRISTS |
Other - Org Type: | Other Name |
Authorized Official - Title/Position: | MSG DIRECTOR |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | NATALIE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | BUSLEPP |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 989-584-3971 |
Mailing Address - Street 1: | 406 E ELM ST |
Mailing Address - Street 2: | PO BOX 730 |
Mailing Address - City: | CARSON CITY |
Mailing Address - State: | MI |
Mailing Address - Zip Code: | 48811-9693 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 989-584-3971 |
Mailing Address - Fax: | 989-584-6734 |
Practice Address - Street 1: | 406 E ELM ST |
Practice Address - Street 2: | |
Practice Address - City: | CARSON CITY |
Practice Address - State: | MI |
Practice Address - Zip Code: | 48811-9693 |
Practice Address - Country: | US |
Practice Address - Phone: | 989-584-3971 |
Practice Address - Fax: | 989-584-6734 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-03-28 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Single Specialty |