Healthcare Provider Details

I. General information

NPI: 1649594284
Provider Name (Legal Business Name): UPPER PENINSULA ASSOCIATION OF RURAL HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2010
Last Update Date: 06/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N16088 S. BALSAM 1.5 LANE
SPALDING MI
49886
US

IV. Provider business mailing address

PO BOX 159
SPALDING MI
49886-0159
US

V. Phone/Fax

Practice location:
  • Phone: 906-497-5516
  • Fax: 906-497-4206
Mailing address:
  • Phone: 906-497-5933
  • Fax: 906-497-4033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301009294
License Number StateMI

VIII. Authorized Official

Name: DONNA JAKSIC
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 906-228-3613