Provider Demographics
NPI:1881877819
Name:MYMICHIGAN MEDICAL CENTER ALPENA
Entity type:Organization
Organization Name:MYMICHIGAN MEDICAL CENTER ALPENA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LOU
Authorized Official - Middle Name:
Authorized Official - Last Name:SYTSMA
Authorized Official - Suffix:
Authorized Official - Credentials:DNP,APRN,BC
Authorized Official - Phone:800-288-7242
Mailing Address - Street 1:4000 WELLNESS DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48670-0001
Mailing Address - Country:US
Mailing Address - Phone:989-356-7274
Mailing Address - Fax:989-356-7320
Practice Address - Street 1:1501 W CHISHOLM ST
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-1401
Practice Address - Country:US
Practice Address - Phone:989-356-7274
Practice Address - Fax:989-356-7320
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MYMICHIGAN HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-13
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6803070889282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6803070889Medicaid