Provider Demographics
NPI:1063414233
Name:MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JORRI
Authorized Official - Middle Name:M
Authorized Official - Last Name:TREMAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-729-4466
Mailing Address - Street 1:826 W KING ST
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-2120
Mailing Address - Country:US
Mailing Address - Phone:989-723-5211
Mailing Address - Fax:989-723-5274
Practice Address - Street 1:826 W KING ST
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867
Practice Address - Country:US
Practice Address - Phone:989-723-5211
Practice Address - Fax:989-723-5274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1060000059282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM004774OtherCHAMPUS IN/OUTPATIENT
MI00058OtherINPATIENT/OUTPATIENT/PSYC
MI0010013OtherHEALTH PLUS IN/OUT PATIEN
MI301557687Medicaid
MI5000009OtherPHP IN/OUTPATIENT
MI405171252Medicaid
MI405171252Medicaid
MI405171252Medicaid