Provider Demographics
NPI:1427054360
Name:PAUL OLIVER MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:PAUL OLIVER MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO SOUTH REIGON
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:MARINOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-352-2259
Mailing Address - Street 1:224 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:MI
Mailing Address - Zip Code:49635-9658
Mailing Address - Country:US
Mailing Address - Phone:231-935-6181
Mailing Address - Fax:231-935-7952
Practice Address - Street 1:224 PARK AVE
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:MI
Practice Address - Zip Code:49635-9658
Practice Address - Country:US
Practice Address - Phone:231-935-6181
Practice Address - Fax:231-935-7952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-24
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI275N00000X, 282N00000X, 313M00000X, 314000000X, 282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
No282N00000XHospitalsGeneral Acute Care Hospital
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1792687Medicaid
MI00149OtherBLUE CROSS HOSPITAL
MI15149OtherBLUE CROSS LTC PRIMARY
MI1557560Medicaid
MI5171628Medicaid
MI09542OtherBLUE CROSS LTC SECONDARY
MI1792687Medicaid
MI09542OtherBLUE CROSS LTC SECONDARY
MI15149OtherBLUE CROSS LTC PRIMARY
MI235460Medicare ID - Type UnspecifiedLONG TERM CARE
MI231300Medicare Oscar/Certification