Organization
MUNSON MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARD B CARLSON (CFO)
(231) 935-5000
Entity
Organization
Contact information
Practice address
1105 6TH ST, TRAVERSE CITY, MI 49684-2349
(231) 935-5000
Mailing address
PO BOX 1131, TRAVERSE CITY, MI 49685-1131
(231) 935-5000
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
500B811000
BLUE SHIELD
—
Enumeration date
06/28/2006
Last updated
05/30/2008
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