=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891889895
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASPIRUS ONTONAGON HOSPITAL, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2006
-----------------------------------------------------
Last Update Date | 03/11/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 601 S 7TH ST
-----------------------------------------------------
City | ONTONAGON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49953-1448
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 906-884-8240
-----------------------------------------------------
Fax | 906-884-4384
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 29980 NETWORK PL
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60673-1299
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-847-2304
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP OF REVENUE CYCLE
-----------------------------------------------------
Name | LORI PECK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 715-847-2000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 1060000116
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------