Basic Information
| Provider Information | |||||||||
| NPI: | 1619238953 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHERN MICHIGAN REGIONAL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 416 CONNABLE AVE | ||||||||
| Address2: | ADMINISTRATION - CEO / (RURAL HEALTH CLINIC) | ||||||||
| City: | PETOSKEY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497702212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2314877684 | ||||||||
| FaxNumber: | 2314877721 | ||||||||
| Practice Location | |||||||||
| Address1: | 740 S MAIN ST | ||||||||
| Address2: | SUITE 3 - MCSS (RHC) | ||||||||
| City: | CHEBOYGAN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 497212220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2316271493 | ||||||||
| FaxNumber: | 2316271312 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2012 | ||||||||
| LastUpdateDate: | 12/06/2017 | ||||||||
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| AuthorizedOfficialLastName: | ZECHMAN | ||||||||
| AuthorizedOfficialFirstName: | DAVE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT, CEO | ||||||||
| AuthorizedOfficialTelephone: | 2314874011 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.