Healthcare Provider Details

I. General information

NPI: 1487758595
Provider Name (Legal Business Name): BARAGA COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 03/28/2014
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: 906-524-3300
  • Fax: 906-524-6218
Mailing address:
  • Phone: 906-524-3300
  • Fax: 906-524-6218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number4301039795
License Number StateMI

VIII. Authorized Official

Name: MR. TIM ZWICKEY
Title or Position: ADMINISTRATOR
Credential: CEO
Phone: 906-524-3321