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SCH230081-01 Munson Healthcare Cadillac Hospital (Terminated)
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Main Details
Name
Munson Healthcare Cadillac Hospital
Subdivision Name
Cadillac Primary Care and OB/GYN
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH230081-01
Medicare Provider Number
230081
Outpatient Facility Provider Number
238635
Additional Details
Current Program Status
Terminated
Registration Date
7/11/2013
Participating Start Date
10/1/2013
Participating Approval Date
9/11/2013
Last Recertification Date
8/19/2021
Termination Date
Termination Reason
4/1/2022
Change of covered entity type
Contacts
Authorizing Official
Munson Healthcare
Alicia Maitland, CFO
(231) 935-7840
Primary Contact
Munson Healthcare
Sam Patrick Niemi, System Director Reimbursement
(231) 935-7761
Addresses
Street Address
7985 Mackinaw Trail
Cadillac, MI 49601
Billing Address
Munson Healthcare Cadillac Hospital
PO Box 669
Traverse City, MI 49685
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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