Provider Demographics
NPI:1912225400
Name:MUNSON MEDICAL CENTER
Entity Type:Organization
Organization Name:MUNSON MEDICAL CENTER
Other - Org Name:MUNSON RHEUMATOLOGY CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HEPLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-935-7450
Mailing Address - Street 1:1221 SIXTH ST
Mailing Address - Street 2:STE. 212
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2701
Mailing Address - Country:US
Mailing Address - Phone:231-392-0210
Mailing Address - Fax:231-392-0211
Practice Address - Street 1:1221 SIXTH ST
Practice Address - Street 2:STE. 212
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2701
Practice Address - Country:US
Practice Address - Phone:231-392-0210
Practice Address - Fax:231-392-0211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-10
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty