=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154480044
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASPIRUS KEWEENAW
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2006
-----------------------------------------------------
Last Update Date | 06/06/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 205 OSCEOLA STREET
-----------------------------------------------------
City | LAURIUM
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49913-2134
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 906-337-6500
-----------------------------------------------------
Fax | 906-337-6597
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 205 OSCEOLA STREET
-----------------------------------------------------
City | LAURIUM
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49913-2134
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 906-337-6500
-----------------------------------------------------
Fax | 906-337-6597
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SVP & CHIEF FINANCIAL OFFICER
-----------------------------------------------------
Name | JERRY M YANG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 715-847-2526
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 275N00000X
-----------------------------------------------------
Taxonomy Name | Medicare Defined Swing Bed Hospital Unit
-----------------------------------------------------
License Number | 23Z319
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------