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General NPI Number Information
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NPI Number | 1104195601
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Entity Type | Organization
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Legal Business Name | UPPER PENINSULA MANAGED CARE, LLC
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Dates
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Enumeration Date | 12/29/2011
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Last Update Date | 12/29/2011
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Provider Practice Location Address
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Address Line | 228 W WASHINGTON ST
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City | MARQUETTE
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State | MI
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Zip | 49855-4330
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Country | US
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Telephone | 906-225-7500
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Fax |
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Provider Business Mailing Address
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Address Line | 228 W WASHINGTON ST
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City | MARQUETTE
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State | MI
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Zip | 49855-4330
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Country | US
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Telephone | 906-225-7500
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Fax |
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | MR. DENNIS SMITH
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Credential |
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Telephone | 906-225-7500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 4704191191
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 4704112142
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 4704192981
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 4704122245
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License Number State | MI
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Taxonomy #5
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 4704114122
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License Number State | MI
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Taxonomy #6
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 4704253641
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License Number State | MI
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