Organization
MUNSON DIALYSIS CENTER
Active
Other names
Traverse Bay Regional Dialysis Center
Organization subpart
No
Provider details
NPI number
Authorized official
KATHLEEN LARAIA (VP ANCILLARY SERVICES)
(231) 935-5000
Entity
Organization
Contact information
Practice address
4062 W ROYAL DR, TRAVERSE CITY, MI 49684-8965
(231) 935-0447
(231) 935-0467
Mailing address
4062 W ROYAL DR, TRAVERSE CITY, MI 49684-8965
(231) 935-5652
(231) 935-7792
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08941
BCBS DIALYSIS
MI
01
—
09479
BCBS SECONDARY DIALYSIS
MI
05
—
2937976
—
MI
Enumeration date
08/31/2006
Last updated
10/03/2024
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