Provider Demographics
NPI:1285726828
Name:MERCY HOSPITAL GRAYLING
Entity type:Organization
Organization Name:MERCY HOSPITAL GRAYLING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:RIEMER-MATUZAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-348-0315
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-0160
Mailing Address - Country:US
Mailing Address - Phone:231-876-7401
Mailing Address - Fax:231-876-7176
Practice Address - Street 1:1100 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:GRAYLING
Practice Address - State:MI
Practice Address - Zip Code:49738-1312
Practice Address - Country:US
Practice Address - Phone:231-876-7401
Practice Address - Fax:231-876-7176
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRINITY HEALTH-MICHIGAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI30-1555753Medicaid
MI40-5171332Medicaid
MI00007OtherBLUE CROSS
MI23-0058Medicare Oscar/Certification