| Organization Name: | OTSEGO MEMORIAL HOSPITAL |
| NPI Number: | 1639420557 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | THOMAS R LEMON (CEO) |
| Mailing Address: | 3860 S Straits Hwy Indian River |
| State: | MI US |
| Postal Code: | 497495136 |
| Phone Number: | 2312380581 |
| Fax Number: | 2312380586 |
| NPI Enumeration Date: | 10/02/2012 |
| NPI Last Update Date: | 12/04/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |