Munson Healthcare Otsego Memorial Hospital
Organization Active NPI General Practice Physician · Gaylord, MI
NPI 1487791695 · NPPES record last updated Aug 22, 2018
Key facts
- NPI
- 1487791695
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Practice Physician 208D00000X
- License
- 690020 (MI)
- Legal business name
- MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL
- Practice address
- 1996 Walden Dr
Gaylord, MI 49735 - Phone
- (989) 731-4111
- Fax
- (989) 705-8511
- NPI assigned
- Jan 30, 2007
- Organization subpart
- No
Authorized official
- Name
- Mr. Thomas R. Lemon
- Title
- Ceo
- Phone
- (989) 731-2230
Other NPIs on the same Medicare enrollment 14
Corporate family (same tax ID) 31
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 |
|---|---|---|---|---|
| General Practice Physician |
208D00000X | 690020 | MI | Yes |
Addresses
Primary practice location
1996 Walden Dr
Gaylord, MI 49735
Mailing address
825 N Center Ave
Gaylord, MI 49735-1592
Phone (989) 731-2100
Other names
- Munson Healthcare OMH Walk-In Clinic
- MedCare WalkIn Clinic
Other providers in Gaylord, MI
- 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 Home Services
- Ashlyn Noel Muntin
All providers in Gaylord, MI · General Practice 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.