Organization
MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL
Active
Other names
Otsego Emergency Physicians
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS LEMON (CEO)
(989) 731-2100
Entity
Organization
Contact information
Practice address
825 N CENTER AVE, GAYLORD, MI 49735
(989) 731-2140
Mailing address
825 N CENTER AVE, GAYLORD, MI 49735-1592
(989) 731-2140
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
700F960010
BLUE CROSS OF MICHIGAN
MI
Enumeration date
08/18/2006
Last updated
08/22/2018
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