Healthcare Provider Details

I. General information

NPI: 1063670453
Provider Name (Legal Business Name): ASPIRUS IRONWOOD HOSPITAL & CLINICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 06/07/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

E6112 E BLUFFVIEW RD SUITE 102
IRONWOOD MI
49938-9367
US

IV. Provider business mailing address

N10565 GRANDVIEW LN
IRONWOOD MI
49938-9622
US

V. Phone/Fax

Practice location:
  • Phone: 906-932-1436
  • Fax: 906-932-1449
Mailing address:
  • Phone: 906-932-1500
  • Fax: 906-932-5630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateNULL

VIII. Authorized Official

Name: JERRY M YANG
Title or Position: SVP & CHIEF FINANCIAL OFFICER
Credential:
Phone: 715-847-2526