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CAH231300-05 PAUL OLIVER MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
PAUL OLIVER MEMORIAL HOSPITAL
Subdivision Name
Interlochen Clinic / Physical Therapy
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH231300-05
Medicare Provider Number
231300
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/30/2014
Participating Start Date
1/1/2015
Participating Approval Date
11/13/2014
Last Recertification Date
8/30/2019
Termination Date
Termination Reason
10/1/2020
Business decision by the Covered Entity
Contacts
Authorizing Official
Paul Oliver Memorial Hospital
PETER MARINOFF, CHIEF OPERATING OFFICER
(231) 352-2259
Primary Contact
Munson Healthcare
Steve Leach, Regional Director, Reimbursement
(231) 935-7797
Addresses
Street Address
1975 Sterling Dr
Interlochen, MI 49643
Billing Address
PAUL OLIVER MEMORIAL HOSPITAL
224 Park Avenue
Frankfort, MI 49635
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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