Healthcare Provider Details

I. General information

NPI: 1841555430
Provider Name (Legal Business Name): BARAGA COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 03/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18341 US HIGHWAY 41
LANSE MI
49946-8024
US

IV. Provider business mailing address

18341 US HIGHWAY 41
LANSE MI
49946-8024
US

V. Phone/Fax

Practice location:
  • Phone: 906-524-6118
  • Fax: 906-524-6218
Mailing address:
  • Phone: 906-524-6118
  • Fax: 906-524-6218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6801073221
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801073221
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301046352
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301053460
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number4301086536
License Number StateMI
# 6
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301078771
License Number StateMI
# 7
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301099797
License Number StateMI
# 8
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateMI

VIII. Authorized Official

Name: MR. TIM ZWICKEY
Title or Position: CEO
Credential:
Phone: 906-524-3322