MUNSON HEALTHCARE OMH MEDICAL GROUP-INDIAN RIVER
NPI 1053661231
General Practice in Indian River, MI

Q: What is Munson Healthcare Otsego Memorial Hospital's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

Active since September 14, 2012CLIA Certified · 3 labs

3860 S STRAITS HWY, INDIAN RIVER, MI 49749(231) 238-0581(231) 238-0856 Get Directions Write a Review

NPPES record last updated: October 18, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Oct 18, 2022, Aug 22, 2018, Sep 22, 2016 and 1 more (4 updates tracked since 2015).

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About Munson Healthcare Omh Medical Group-indian River NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MUNSON HEALTHCARE OMH MEDICAL GROUP-INDIAN RIVER (NPI 1053661231) is a healthcare organization registered as a general practice in Indian River, Michigan and active in the NPI registry since September 2012. The organization holds 3 active CLIA laboratory certificates and lists Ellen O Smith, Ceo, as its authorized official.

NPPES Registry Identity

NPI1053661231

Entity TypeOrganization

Primary Taxonomy208D00000X

Legal Business NameMUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL

Location Address3860 S STRAITS HWYIndian River, MI 49749

Mailing Address271 Mccoy Rd WGaylord, MI 49735-8253 · (989) 731-7777 · Fax (989) 731-7776

Phone(231) 238-0581

Fax(231) 238-0856

Organization SubpartNo

Authorized OfficialEllen O SmithCeo · (989) 731-2230

Enumeration DateSeptember 14, 2012

Last NPPES UpdateOctober 18, 20224 updates tracked since enumeration

NPPES CertifiedOctober 18, 2022

✔ NPI 1053661231 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians

Taxonomy Code208D00000X

Definition

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

3860 S STRAITS HWY, Indian River, MI 49749

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Other Names 2

Doing Business AsMunson Healthcare Omh Medical Group-indian River

Doing Business AsOmh Medical Group - Indian River

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA 3

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 23D2048394

Munson Healthcare Omh Medical Group - Indian River · Indian River, MI

Active · expires Jun 20, 2027

CLIA Number23D2048394

Laboratory TypeRural Health Clinic

Certificate Effective DateJune 21, 2025

Certificate Expiration DateJune 20, 2027

Laboratory DirectorBenjamin Vanos

Laboratory Phone(231) 238-0581

Laboratory LocationMunson Healthcare Omh Medical Group - Indian River3860 S Straights Highway, Indian River, MI 49749

CLIA data matches this NPI record on: Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Certificate of Accreditation 23D0038025

Munson Healthcare Otsego Memorial Hospital · Gaylord, MI

Active · expires Jan 2, 2027

CLIA Number23D0038025

Laboratory TypeHospital

Certificate Effective DateJanuary 3, 2025

Certificate Expiration DateJanuary 2, 2027

Laboratory DirectorDr. William A. Kanner

Laboratory Phone(989) 731-2183

Laboratory LocationMunson Healthcare Otsego Memorial Hospital825 N Center Avenue, Gaylord, MI 49735

CLIA data matches this NPI record on: Name

This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 23D1062477

Munson Healthcare Otsego · Gaylord, MI

Active · expires Dec 14, 2026

CLIA Number23D1062477

Laboratory TypeRural Health Clinic

Certificate Effective DateDecember 15, 2024

Certificate Expiration DateDecember 14, 2026

Laboratory DirectorChangxin Li

Laboratory Phone(989) 731-7870

Laboratory LocationMunson Healthcare Otsego829 N Center Ave, Gaylord, MI 49735

CLIA data matches this NPI record on: Name

This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MARJORIE LEE BEIGLE AGNP

Nurse Practitioner (Adult Health)