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SCH230222-16 MIDMICHIGAN MEDICAL CTR (Terminated)
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Main Details
Name
MIDMICHIGAN MEDICAL CTR
Subdivision Name
MIDMICHIGAN MEDICAL CENTER MIDLAND - Dermatology - Midland
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH230222-16
Medicare Provider Number
230222
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/6/2017
Participating Start Date
1/1/2018
Participating Approval Date
10/31/2017
Last Recertification Date
Termination Date
Termination Reason
10/1/2018
Site closure
Contacts
Authorizing Official
MidMichigan Health
Bryan Rex Cross, President
(989) 839-1322
Primary Contact
MidMichigan Health
Bryan Rex Cross, President
(989) 839-1322
Addresses
Street Address
728 W WACKERLY ST
STE 200
MIDLAND, MI 48640-4724
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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