Munson Healthcare Otsego Memorial Hospital
Organization Active NPI Emergency Medical Services (Emergency Medicine) Physician · Gaylord, MI
NPI 1376657239 · NPPES record last updated Aug 22, 2018
Key facts
- NPI
- 1376657239
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Emergency Medical Services (Emergency Medicine) Physician 207PE0004X
- Legal business name
- MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL
- Practice address
- 825 N Center Ave
Gaylord, MI 49735 - Phone
- (989) 731-2140
- NPI assigned
- Aug 18, 2006
- Organization subpart
- No
Authorized official
- Name
- Thomas Lemon
- Title
- Ceo
- Phone
- (989) 731-2100
Other NPIs on the same Medicare enrollment 14
Corporate family (same tax ID) 31
Practitioners 61
-
Robert E Carmody, M.D.
-
Curtis J. Devries, CRNA
-
Timothy G Esser, MD
-
Michael H Florek, D.O.
-
Wayne A Fuller, MD
-
Shannon Christine Gabel, PA-C
-
Louis S Habryl, DO
-
Lindsay Michelle Harden, D.O.
-
Janelle Howe Hendrian, D.O.
-
Soo Young Hwang, MD
-
Dawn Michelle Jones, CRNA
-
Yasser Kouatli, MD
-
David J Kurn, M.D.
-
Jennifer Lawhorn, DO
-
Eric Lerche, D.O.
-
Changxin Li, M.D.
-
Steven Mancini, CRNA
-
Kristin S Maschke, M.D.
-
Matthew A Mazur, D.O.
-
Bethany McKinley, CRNA
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040305000525 | MI | Part B Supplier - Clinic/Group Practice | 8325942535 |
Receives reassigned benefits from 186 practitioners 14 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Gaylord, MI; Petoskey, MI; Lewiston, MI; Indian River, MI; Grayling, MI; Elmira, MI |
National Provider Directory
- Tax ID family
- Munson Healthcare Otsego Memorial Hospital
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medical Services (Emergency Medicine) Physician |
207PE0004X | Yes |
Addresses
Primary practice location
825 N Center Ave
Gaylord, MI 49735
Mailing address
825 N Center Ave
Gaylord, MI 49735-1592
Phone (989) 731-2140
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 700F960010 | Other | MI | BLUE CROSS OF MICHIGAN |
Other names
- Otsego Emergency Physicians
Other providers in Gaylord, MI
- Madison Mundy
- Munson Healthcare Otsego Memorial Hospital
- Munson Healthcare Otsego Memorial Hospital
- Munson Healthcare Otsego Memorial Hospital
- Munson Healthcare Otsego Memorial Hospital
- Munson Healthcare Otsego Memorial Hospital
- Munson Healthcare Otsego Memorial Hospital
- Munson Healthcare Otsego Memorial Hospital
- Munson Healthcare Otsego Memorial Hospital
- Munson Healthcare Otsego Memorial Hospital
All providers in Gaylord, MI · Emergency Medical Services (Emergency Medicine) Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.