Provider Demographics
NPI:1881021095
Name:MUNSON HEALTHCARE MANISTEE HOSPITAL
Entity type:Organization
Organization Name:MUNSON HEALTHCARE MANISTEE HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:HEPLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-935-5000
Mailing Address - Street 1:1465 E PARKDALE AVE
Mailing Address - Street 2:
Mailing Address - City:MANISTEE
Mailing Address - State:MI
Mailing Address - Zip Code:49660-9785
Mailing Address - Country:US
Mailing Address - Phone:231-398-1000
Mailing Address - Fax:231-398-1198
Practice Address - Street 1:1400 E PARKDALE AVE
Practice Address - Street 2:
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-9776
Practice Address - Country:US
Practice Address - Phone:231-398-1840
Practice Address - Fax:231-398-1835
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MUNSON HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-10-02
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health