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SCH230058-06 Munson Healthcare Grayling Hospital (Terminated)
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Main Details
Name
Munson Healthcare Grayling Hospital
Subdivision Name
Grayling Community Health Center - Elder Care
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH230058-06
Medicare Provider Number
230058
Outpatient Facility Provider Number
238561
Additional Details
Current Program Status
Terminated
Registration Date
7/9/2019
Participating Start Date
10/1/2019
Participating Approval Date
8/5/2019
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
1250 E. Michigan Avenue
Grayling, MI 49738
Billing Address
Munson Healthcare Grayling Hospital
PO Box 669
Traverse City, MI 49685-0669
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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