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DSH230081B MUNSON HEALTHCARE CADILLAC HOSPITAL (Active)
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Main Details
Name
MUNSON HEALTHCARE CADILLAC HOSPITAL
Subdivision Name
MUNSON HEALTHCARE CADILLAC - MCBAIN PRIMARY CARE
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH230081B
Medicare Provider Number
230081
Outpatient Facility Provider Number
238711
Additional Details
Current Program Status
Active
Registration Date
1/14/2022
Participating Start Date
4/1/2022
Participating Approval Date
2/23/2022
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
100 N ROLAND ST
MCBAIN PRIMARY CARE
MCBAIN, MI 49657-9683
Billing Address
Munson Healthcare Cadillac Hospital
PO Box 669
Traverse City, MI 49685
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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