Provider Demographics
NPI:1720484504
Name:MUNSON HEALTHCARE GRAYLING
Entity Type:Organization
Organization Name:MUNSON HEALTHCARE GRAYLING
Other - Org Name:MUNSON HEALTHCARE CRAWFORD CONTINUING CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AMBULATORY CLINICS
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:O
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-935-7840
Mailing Address - Street 1:1105 SIXTH ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2349
Mailing Address - Country:US
Mailing Address - Phone:231-935-5000
Mailing Address - Fax:
Practice Address - Street 1:1100 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:GRAYLING
Practice Address - State:MI
Practice Address - Zip Code:49738-1312
Practice Address - Country:US
Practice Address - Phone:989-348-0594
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MUNSON HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-06
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI00030OtherBLUE CROSS
MI235201Medicaid
MI235201Medicare Oscar/Certification