# MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL

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- **Entity:** Organization
- **Status:** Active
- **Other names:** OTSEGO MEMORIAL HOSPITAL
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477615086
- **Authorized official:** KATHLEEN LARAIA (VP, ANCILLARY SERVICES)
- **Authorized official phone:** (231) 392-8410

## Contact information

- **Practice address:** 825 N CENTER AVE, GAYLORD, MI 49735
- **Practice address phone:** (989) 731-2163
- **Practice address fax:** (989) 731-2162
- **Mailing address:** 825 N CENTER AVE, GAYLORD, MI 49735-1592
- **Mailing address phone:** (989) 731-2163
- **Mailing address fax:** (989) 731-2162

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 5301002513 | MI | — |
| 3336I0012X | Institutional Pharmacy | — | NULL | Yes |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 12/14/2006
- **Last updated:** 07/17/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2041951 | PK | — |
| 05 | — | 5171589 | — | MI |