Provider Demographics
NPI:1306555917
Name:MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-935-9283
Mailing Address - Street 1:2572 N US HIGHWAY 131
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:MI
Mailing Address - Zip Code:49730-8252
Mailing Address - Country:US
Mailing Address - Phone:989-731-7700
Mailing Address - Fax:231-213-8714
Practice Address - Street 1:2572 N US HIGHWAY 131
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:MI
Practice Address - Zip Code:49730-8252
Practice Address - Country:US
Practice Address - Phone:989-731-7700
Practice Address - Fax:231-213-8714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-22
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine