NPIMap

Organization Active NPI

Munson Healthcare Manistee

Doing business as West Shore Medical Center Physician Services

  • Surgery Physician
  • Manistee, MI
National Provider Identifier
1144512849
Registry record updated Sep 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
MUNSON HEALTHCARE MANISTEE
Doing business as
West Shore Medical Center Physician Services
Practice address
1293 E Parkdale Ave
Manistee, MI 49660-8904
Phone
(231) 398-1750
Fax
(231) 398-1751
NPI assigned
May 12, 2011
Last updated
Sep 22, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ellen O Smith
Title
President Ambulatory Clinics
Phone
(231) 935-5000

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MI
Gynecology Physician 207VG0400X MI
Orthopaedic Surgery Physician 207X00000X MI
Pediatrics Physician 208000000X MI
Surgery Physician 208600000X MI Primary

Addresses

Primary practice location

1293 E Parkdale Ave
Manistee, MI 49660-8904

Mailing address

315 Oakgrove St
Manistee, MI 49660-1176
Phone (231) 398-9266

Other names 1

  • West Shore Medical Center Physician Services Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D0936718Munson Healthcare Manistee Physician Offices1293 E Parkdale Ave, Manistee, MI 49660Certificate of waiverMar 14, 2028

National Provider Directory

National Provider Directory
Tax ID family
Munson Healthcare Manistee2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1293 E Parkdale Ave
Manistee, MI 49660
Phone (231) 398-1735

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1305158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663804800000",
    "number": "1144512849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 OAKGROVE ST",
            "city": "MANISTEE",
            "state": "MI",
            "postal_code": "496601176",
            "telephone_number": "231-398-9266",
            "fax_number": "231-398-9268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1293 E PARKDALE AVE",
            "city": "MANISTEE",
            "state": "MI",
            "postal_code": "496608904",
            "telephone_number": "231-398-1750",
            "fax_number": "231-398-1751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MUNSON HEALTHCARE MANISTEE",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-12",
        "last_updated": "2022-09-22",
        "certification_date": "2022-09-22",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "ELLEN",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "PRESIDENT AMBULATORY CLINICS",
        "authorized_official_telephone_number": "231-935-5000"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": null,
            "primary": false
        },
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "MI",
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "MI",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "West Shore Medical Center Physician Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "West Shore Medical Center Physician Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Manistee, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.