Munson Medical Center

Organization Active NPI Nurse Practitioner · Traverse City, MI

NPI 1477581759 · NPPES record last updated May 30, 2008

Key facts

NPI
1477581759
Entity type
Organization (NPI type 2)
Primary specialty
Nurse Practitioner 363L00000X
Legal business name
MUNSON MEDICAL CENTER
Practice address
1105 6TH St
Traverse City, MI 49684-2349
Phone
(231) 935-5000
NPI assigned
Jun 28, 2006
Organization subpart
No

Authorized official

Name
Edward B Carlson
Title
Cfo
Phone
(231) 935-5000

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Other NPIs with the same Medicare PAC ID 11

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Practitioners 385

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 385

Medicare participation

Medicare fee-for-service enrollment
Enrolled in MI

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20040827000534 MI Part B Supplier - Clinic/Group Practice 3072426287 Receives reassigned benefits from 13 practitioners
1 other NPI on this enrollment
Practice locations: Traverse City, MI

National Provider Directory

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner
Group: 193200000X MULTI-SPECIALTY GROUP
363L00000X Yes

Addresses

Primary practice location

1105 6TH St
Traverse City, MI 49684-2349

Mailing address

PO Box 1131
Traverse City, MI 49685-1131
Phone (231) 935-5000

Other identifiers

IdentifierTypeStateIssuer
500B811000OtherBLUE SHIELD
500B811000OtherBLUE CARE NETWORK

Other providers in Traverse City, MI

All providers in Traverse City, MI · Nurse Practitioner in Michigan

Sources for this page

Verify at the official NPI Registry.