Provider Demographics
NPI:1043441975
Name:MYMICHIGAN MEDICAL CENTER ALPENA
Entity type:Organization
Organization Name:MYMICHIGAN MEDICAL CENTER ALPENA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:H
Authorized Official - Last Name:SHERWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-356-7245
Mailing Address - Street 1:1501 W CHISHOLM ST
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-1401
Mailing Address - Country:US
Mailing Address - Phone:989-356-7285
Mailing Address - Fax:989-356-7305
Practice Address - Street 1:12674 JEROME ST.
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:MI
Practice Address - Zip Code:49709
Practice Address - Country:US
Practice Address - Phone:989-785-5360
Practice Address - Fax:989-785-5771
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MYMICHIGAN HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-27
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5170059Medicaid
MI5170059Medicaid