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SCH230081-03 Munson Healthcare Cadillac Hospital (Terminated)
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Main Details
Name
Munson Healthcare Cadillac Hospital
Subdivision Name
MUNSON HEALTHCARE CADILLAC - Urgent Care
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH230081-03
Medicare Provider Number
230081
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/2/2020
Participating Start Date
4/1/2020
Participating Approval Date
3/5/2020
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
302 HOBART ST
CADILLAC, MI 49601-2379
Billing Address
Munson Healthcare Cadillac Hospital
400 Hobart St.
Cadillac, MI 49601
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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