Provider Demographics
NPI:1700805157
Name:SCHOOLCRAFT MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:SCHOOLCRAFT MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
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:906-341-3200
Mailing Address - Fax:906-341-1878
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:906-341-3200
Practice Address - Fax:906-341-1878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM013458SIOtherTRICARE
MI00193OtherBLUE CROSS BLUE SHIELD
MI40-5171860Medicaid
MI30-1556984Medicaid
MI00193OtherBLUE CROSS BLUE SHIELD