Provider Demographics
NPI:1699832279
Name:MYMICHIGAN MEDICAL CENTER SAULT
Entity Type:Organization
Organization Name:MYMICHIGAN MEDICAL CENTER SAULT
Other - Org Name:CHIPPEWA COUNTY WAR MEMORIAL HOSPITAL, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
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:906-635-4456
Mailing Address - Street 1:500 OSBORN BLVD
Mailing Address - Street 2:
Mailing Address - City:SAULT SAINTE MARIE
Mailing Address - State:MI
Mailing Address - Zip Code:49783-1822
Mailing Address - Country:US
Mailing Address - Phone:906-635-4460
Mailing Address - Fax:
Practice Address - Street 1:500 OSBORN BLVD
Practice Address - Street 2:
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783-1822
Practice Address - Country:US
Practice Address - Phone:906-635-4460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICS081266204D00000X
MIRW076972207Q00000X
MIDW057132207Q00000X
MI4301037635207V00000X
MIAD082728208600000X
MI4301088941208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI233952Medicare Oscar/Certification
MI0A76002Medicare ID - Type Unspecified
MI238541Medicare Oscar/Certification