Provider Demographics
NPI:1063598845
Name:MUNSON HEALTHCARE CHARLEVOIX HOSPITAL
Entity type:Organization
Organization Name:MUNSON HEALTHCARE CHARLEVOIX HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILHELM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-547-4024
Mailing Address - Street 1:14700 LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLEVOIX
Mailing Address - State:MI
Mailing Address - Zip Code:49720-1931
Mailing Address - Country:US
Mailing Address - Phone:231-547-4024
Mailing Address - Fax:231-547-8088
Practice Address - Street 1:14734 PARK AVE
Practice Address - Street 2:
Practice Address - City:CHARLEVOIX
Practice Address - State:MI
Practice Address - Zip Code:49720-1931
Practice Address - Country:US
Practice Address - Phone:231-547-4024
Practice Address - Fax:231-547-8088
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MUNSON HEALTHCARE CHARLEVOIX HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-27
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1001019OtherCRNA MCLAREN HEALTH PLAN
MI134141100OtherCRNA COMP CARRIER US POST
MI20139OtherCRNA PRIORITY HLTH PRO
MI0A51005OtherCRNA BCN PROFESSIONAL
MI1001019OtherCRNA MCLAREN HEALTH PLAN
0M32060Medicare PIN
MI20139OtherCRNA PRIORITY HLTH PRO
MI=========OtherCRNA PPOM
MI0M32060Medicare PIN