Provider Demographics
NPI:1790867216
Name:MUNSON HEALTHCARE CHARLEVOIX HOSPITAL
Entity Type:Organization
Organization Name:MUNSON HEALTHCARE CHARLEVOIX HOSPITAL
Other - Org Name:MUNSON HEALTHCARE BOYNE AREA HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILHELM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-547-8511
Mailing Address - Street 1:223 N PARK ST
Mailing Address - Street 2:
Mailing Address - City:BOYNE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49712-1220
Mailing Address - Country:US
Mailing Address - Phone:231-582-5314
Mailing Address - Fax:231-582-5338
Practice Address - Street 1:223 N PARK ST
Practice Address - Street 2:
Practice Address - City:BOYNE CITY
Practice Address - State:MI
Practice Address - Zip Code:49712-1220
Practice Address - Country:US
Practice Address - Phone:231-582-5314
Practice Address - Fax:231-582-5338
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MUNSON HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-20
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI31459366OtherFIRST HEALTH FP GROUP
MI0A51004OtherBCN FP PROFESSIONAL GRP
MI900001729OtherPRIORITY HEALTH FP GROUP
MI0A51004OtherBLUE SHIELD FP GROUP
0M32390Medicare PIN
MI0A51004OtherBCN FP PROFESSIONAL GRP
MI0A51004OtherBLUE SHIELD FP GROUP
MI=========002OtherHUMANA GOLD CHOICE FP GRP
MI=========101OtherCOMMUNITY CHOICE FP GROUP
MI=========OtherCHAMP VA FP GROUP
MI=========003OtherTRICARE FP GROUP