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SCH230133-12 MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL (Active)
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Main Details
Name
MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL
Subdivision Name
OMH Medical Group - Gaylord - Internal Medicine
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH230133-12
Medicare Provider Number
230133
Outpatient Facility Provider Number
238607
Additional Details
Current Program Status
Active
Registration Date
4/7/2021
Participating Start Date
7/1/2021
Participating Approval Date
6/3/2021
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
829 N CENTER AVE
GAYLORD, MI 49735
Billing Address
Munson Healthcare Ostego Memorial Hospital
825 N. Center Ave.
Gaylord, MI 49735
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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