1154434249 NPI number — ASPIRUS IRONWOOD HOSPITAL & CLINICS, INC.

Table of content: SUZANNE MOORE (NPI 1396919502)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154434249 NPI number — ASPIRUS IRONWOOD HOSPITAL & CLINICS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASPIRUS IRONWOOD HOSPITAL & CLINICS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ASPIRUS GRAND VIEW
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154434249
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/27/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
N10565 GRANDVIEW LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRONWOOD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49938-9622
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
906-932-1500
Provider Business Mailing Address Fax Number:
906-932-5630

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 GRANITE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HURLEY
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54534-1372
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-561-2255
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHERMSIDE
Authorized Official First Name:
PAULA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
906-932-2525

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 383005582010 . This is a "BLUE CROSS BLUE SHIELD WI" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 700B710030 . This is a "BLUE CROSS BLUE SHIELD MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 02W43GR . This is a "BLUE CROSS BLUE SHIELD MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 383005582003 . This is a "HEALTHNET FEDERAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 32849900 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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