MUNSON HEALTHCARE GRAYLING (NPI# 1144626052) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144626052 |
| Entity Type | Organization |
| Organization Name | MUNSON HEALTHCARE GRAYLING |
| Other Organization Name | PRUDENVILLE COMMUNITY HEALTH CENTER |
| Practice Address |
2585 W Houghton Lake Dr Prudenville MI 48651-9624 |
| Mailing Address |
1105 Sixth St Traverse City MI 49684-2349 |
| Practice Telephone | 9893662900 |
| Mailing Telephone | 2319355000 |
| Enumeration Date | 2014-11-05 |
| Last Update Date | 2015-09-17 |
| Authorized Official Name | MR. MARK A HEPLER (CFO) |
| Authorized Official Telephone | 2319355000 |
| Is Organization Subpart | Y |
| Parent Organization Name | MUNSON HEALTHCARE |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | 238562 | 05 | |
| MI | BLUE CROSS | 00030 | 01 |
| Other Name | Type Code |
|---|---|
| PRUDENVILLE COMMUNITY HEALTH CENTER | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235788639 | Munson Healthcare Grayling | Family Medicine | 1321 S Mount Tom Rd, Mio, MI 48647-9518 | 2019-09-09 |
| 1699275750 | Munson Healthcare Grayling | Psychologist | 1200 W North Down River Rd., Suite C, Grayling, MI 49738 | 2018-02-15 |
| 1508492133 | Munson Healthcare Grayling | Internal Medicine | 1200 W North Down River Rd Ste C, Grayling, MI 49738-8024 | 2020-03-16 |
| 1093349698 | Munson Healthcare Grayling | Clinic/Center | 1321 S Mount Tom Rd, Mio, MI 48647-9518 | 2020-02-24 |
| 1235789751 | Munson Healthcare Grayling | Clinic/Center | 1321 S Mount Tom Rd, Mio, MI 48647-9518 | 2019-09-17 |
| 1245892546 | Munson Healthcare Grayling | Audiologist | 1250 E Michigan Ave Ste C, Grayling, MI 49738-7074 | 2019-07-08 |
| 1598131617 | Munson Healthcare Grayling | Psychologist | 234 Lake St, Roscommon, MI 48653-9203 | 2015-08-12 |
| 1952787129 | Munson Healthcare Grayling | Psychologist | 2585 W Houghton Lake Dr, Prudenville, MI 48651-9624 | 2015-08-10 |
| 1689050858 | Munson Healthcare Grayling | Psychologist | 1250 E Michigan Ave, Grayling, MI 49738-7074 | 2015-08-10 |
| 1578961660 | Munson Healthcare Grayling | Orthopaedic Surgery | 1100 E Michigan Ave, Grayling, MI 49738-1312 | 2014-12-05 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | MUNSON HEALTHCARE GRAYLING HOSPITAL | 1100 E Michigan Ave, Grayling, MI 49738-1312 |
| Street Address |
2585 W HOUGHTON LAKE DR |
| City | PRUDENVILLE |
| State | MI |
| Zip Code | 48651-9624 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023074960 | Cynthia K Rubert | Orthopaedic Surgery | 2585 W Houghton Lake Dr, Prudenville, MI 48651-9624 | 2006-04-20 |
| 1790209161 | Tammy Marie Milbocker | Nurse Practitioner | 2585 W Houghton Lake Dr, Prudenville, MI 48651-9624 | 2017-07-27 |
| 1952779555 | Devinn L Jeffers | Physician Assistant | 2585 W Houghton Lake Dr, Prudenville, MI 48651-9624 | 2015-09-13 |
| 1952787129 | Munson Healthcare Grayling | Psychologist | 2585 W Houghton Lake Dr, Prudenville, MI 48651-9624 | 2015-08-10 |
| 1275914244 | Nicholas William Blank | Family Medicine | 2585 W Houghton Lake Dr, Prudenville, MI 48651-9624 | 2015-06-15 |
| 1184977811 | Mercy Physician Network | Clinic/Center | 2585 W Houghton Lake Dr, Prudenville, MI 48651-9624 | 2012-10-18 |
| 1942561964 | Amanda Catherine Scott | Nurse Practitioner | 2585 W Houghton Lake Dr, Prudenville, MI 48651-9624 | 2012-06-06 |
| 1487974184 | James Gee | Internal Medicine | 2585 W Houghton Lake Dr, Prudenville, MI 48651-9624 | 2010-06-03 |
| 1346481553 | Mercy Hospital Grayling | Psychologist | 2585 W Houghton Lake Dr, Prudenville, MI 48651-9624 | 2009-03-18 |
| 1154571438 | Mhsn Primary Care Services | Psychologist | 2585 W Houghton Lake Dr, Prudenville, MI 48651-9624 | 2008-09-24 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710469036 | Stephenie Irish | Behavior Technician | Rise Center for Autism, 1840 West Houghton Lake Dr Unit 2, Prudenville, MI 48651 | 2018-09-04 |
| 1083965404 | Mercy Physician Network | Clinic/Center | 2585 W Houghton Lake Drive, Prudenville, MI 48651 | 2012-09-25 |
| 1609976968 | Kronner Pharmacy Inc | Pharmacy | 778 W Houghton Lake Dr, Prudenville, MI 48651 | 2006-09-25 |
| 1255352936 | Mclaren Primary Care | Family Medicine | 200 N. Grand Ave, Prudenville, MI 48651 | 2006-07-21 |
| 1053381871 | Marvin Earl Mcelroy | Internal Medicine | 1064 W West Branch Rd, Prudenville, MI 48651 | 2006-01-24 |
| 1598390080 | Rhiannon Burch | Behavior Technician | Rise Center for Autism, 1070 W. Houghton Lake Drive, Prudenville, MI 48651 | 2020-03-05 |
| 1629357090 | Mclaren Bay Region | Nurse Practitioner | 200 Grand Ave, Prudenville, MI 48651 | 2011-08-16 |
| 1427320894 | Patricia Henning Caswell | Counselor | 1401 Short Dr., Prudenville, MI 48651-0019 | 2012-02-01 |
| 1023015104 | Suzanne A Blanchard | Nurse Practitioner | 1401 Short Drive, Prudenville, MI 48651-0019 | 2005-07-05 |
| 1023640992 | Julie Ignatowski | Speech-Language Pathologist | 847 Springwood Dr, Prudenville, MI 48651-8405 | 2020-02-10 |
| Find all providers in zip 48651 | ||||
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578516498 | Mhsn Primary Care Services | Clinic/Center | 2585 W Houghton Lake Dr, Prudenville, MI 48651-9624 | 2006-05-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487274940 | Mclaren Central Michigan | Clinic/Center | 2853 Health Pkwy, Mt Pleasant, MI 48858-9374 | 2020-04-24 |
| 1821618687 | Mclaren Central Michigan | Clinic/Center | 3520 N Woodruff Rd, Weidman, MI 48893-7734 | 2020-04-22 |
| 1932747946 | Mckenzie Memorial Hospital | Clinic/Center | 170 W Argyle Street, Sandusky, MI 48471 | 2019-12-20 |
| 1326681461 | Munson Healthcare Charlevoix Hospital | Clinic/Center | 14719 W Upright St, Charlevoix, MI 49720-1949 | 2019-10-22 |
| 1881254605 | Schoolcraft Memorial Hospital | Clinic/Center | W11650 Us Highway 2, Naubinway, MI 49762-5116 | 2019-06-14 |
| 1093370264 | Samaritan Health Care, PC | Clinic/Center | 4361 220th Ave, Reed City, MI 49677-8594 | 2019-05-03 |
| 1457916637 | Samaritan Health Care, PC | Clinic/Center | 5916 Us Highway 31 S, Charlevoix, MI 49720-9703 | 2019-05-03 |
| 1033621263 | Caro Community Hospital | Clinic/Center | 345 N State St, Caro, MI 48723-1537 | 2017-10-27 |
| 1275050726 | Hills & Dales General Hospital, Inc. | Clinic/Center | 130 Millwood Street, Caro, MI 48723-1630 | 2017-08-25 |
| 1275932329 | Sturgis Hospital, Inc. | Clinic/Center | 111 S Saint Joseph St, Colon, MI 49040-9342 | 2014-08-14 |
| Find all providers with the same taxonomy | ||||
| City | PRUDENVILLE |
| Zip Code | 48651 |
Please comment or provide details below to improve the information on MUNSON HEALTHCARE GRAYLING.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.