Healthcare Provider Details

I. General information

NPI: 1770687931
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: 06/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 MEMORIAL ST
LANSE MI
49946-1138
US

IV. Provider business mailing address

510 MEMORIAL ST
LANSE MI
49946-1138
US

V. Phone/Fax

Practice location:
  • Phone: 906-524-7156
  • Fax:
Mailing address:
  • Phone: 906-524-7156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: KEN L. PEPIN JR.
Title or Position: PRACTICE MANAGER
Credential:
Phone: 906-524-3435