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SCH230097-00 MUNSON MEDICAL CENTER (Active)
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Main Details
Name
MUNSON MEDICAL CENTER
Subdivision Name
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH230097-00
Medicare Provider Number
230097
Additional Details
Current Program Status
Active
Registration Date
1/9/2017
Participating Start Date
4/1/2017
Participating Approval Date
2/27/2017
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
1105 SIXTH STREET
TRAVERSE CITY, MI 49684
Billing Address
Munson Medical Center
PO Box 669
Traverse City, MI 49685-0669
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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