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SCH230058-14 MUNSON HEALTHCARE GRAYLING HOSPITAL (Active)
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Main Details
Name
MUNSON HEALTHCARE GRAYLING HOSPITAL
Subdivision Name
Traverse Heart & Vascular - Grayling - Heart and Vascular
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH230058-14
Medicare Provider Number
230058
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/15/2024
Participating Start Date
4/1/2024
Participating Approval Date
2/7/2024
Last Recertification Date
8/20/2024
Contacts
Authorizing Official
Munson Healthcare
Kathleen M LaRaia, Vice President
(231) 392-8410
Primary Contact
Munson Healthcare
Sam Patrick Niemi, System Director Reimbursement
(231) 935-7761
Addresses
Street Address
1107 East Michigan Avenue
Grayling, MI 49738
Billing Address
Munson Healthcare Grayling Hospital
PO Box 669
Traverse City, MI 49685-0669
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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