Healthcare Provider Details

I. General information

NPI: 1649320524
Provider Name (Legal Business Name): ASPIRUS KEWEENAW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 CALUMET STREET
LAKE LINDEN MI
49945-1308
US

IV. Provider business mailing address

205 OSCEOLA STREET
LAURIUM MI
49913-2134
US

V. Phone/Fax

Practice location:
  • Phone: 906-296-5040
  • Fax: 906-296-1006
Mailing address:
  • Phone: 906-337-6560
  • Fax: 906-337-6562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

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