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CAH231322-04 MUNSON HEALTHCARE CHARLEVOIX HOSPITAL (Terminated)
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Main Details
Name
MUNSON HEALTHCARE CHARLEVOIX HOSPITAL
Subdivision Name
MUNSON HEALTHCARE / Charlevoix Family Medicine
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH231322-04
Medicare Provider Number
231322
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/7/2014
Participating Start Date
1/1/2015
Participating Approval Date
12/5/2014
Last Recertification Date
8/19/2021
Termination Date
Termination Reason
4/1/2022
Business decision by the Covered Entity
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
14705 W. Upright St.
Charlevoix, MI 49720
Billing Address
Munson Healthcare Charlevoix Hospital
14700 Lake Shore Drive
Charlevoix, MI 49720
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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