=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912689324
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASPIRUS IRONWOOD HOSPITAL & CLINICS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2023
-----------------------------------------------------
Last Update Date | 06/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 229 W GENESEE ST
-----------------------------------------------------
City | IRON RIVER
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49935-1438
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 906-265-9931
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 29980 NETWORK PL
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60673-1299
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-847-2304
-----------------------------------------------------
Fax | 715-843-1188
-----------------------------------------------------
=====================================================
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 | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------