1649594284 NPI number — UPPER PENINSULA ASSOCIATION OF RURAL HEALTH SERVICES, INC.

Table of content: (NPI 1649594284)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649594284 NPI number — UPPER PENINSULA ASSOCIATION OF RURAL HEALTH SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UPPER PENINSULA ASSOCIATION OF RURAL HEALTH SERVICES, 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:
Provider Other Organization Name Type Code:
6
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:
1649594284
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 159
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPALDING
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49886-0159
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
906-497-5933
Provider Business Mailing Address Fax Number:
906-497-4033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
N16088 S. BALSAM 1.5 LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPALDING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49886
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
906-497-5516
Provider Business Practice Location Address Fax Number:
906-497-4206
Provider Enumeration Date:
03/25/2010

Additional Information

Authorized Official

Authorized Official Last Name:
JAKSIC
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
906-228-3613

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  5301009294 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2374104 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1649594284 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com