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General NPI Number Information
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NPI Number | 1679804058
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Entity Type | Organization
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Legal Business Name | UPPER PENINSULA ASSOC. OF RURAL HEALTH SERVICES INC.
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Dates
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Enumeration Date | 01/25/2010
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Last Update Date | 01/25/2010
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Provider Practice Location Address
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Address Line | 220 W WASHINGTON ST STE 430
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City | MARQUETTE
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State | MI
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Zip | 49855-4346
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Country | US
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Telephone | 906-228-3655
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Fax |
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Provider Business Mailing Address
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Address Line | 6150 GREELEY AVE NE
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City | ROCKFORD
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State | MI
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Zip | 49341-8061
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Country | US
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Telephone | 616-204-9638
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MS. DONNA JAKSIC
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Credential |
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Telephone | 906-228-3655
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 4704142802
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License Number State | MI
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