Basic Information
| Provider Information | |||||||||
| NPI: | 1831295708 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARSON CITY HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 879 | ||||||||
| Address2: | 406 E. ELM STREET | ||||||||
| City: | CARSON CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488110879 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9895843131 | ||||||||
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| Practice Location | |||||||||
| Address1: | 406 E ELM ST | ||||||||
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| City: | CARSON CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488119693 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9895843131 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2006 | ||||||||
| LastUpdateDate: | 10/25/2012 | ||||||||
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| AuthorizedOfficialLastName: | THOMPSON | ||||||||
| AuthorizedOfficialFirstName: | MATTHEW | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9895843971 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NR1301X | 5301002431 | MI | Y | Hospitals | General Acute Care Hospital | Rural |
ID Information
| ID | Type | State | Issuer | Description | 301557678 | 05 | MI | MEDICAID |