MEDICARE: IRON COUNTY MEDICAL CARE FACILITY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0401X	Comprehensive Outpatient Rehabilitation Facility (CORF)	368510	MI
2	314000000X	Skilled Nursing Facility	368510	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	30436	OTHER	MI	BLUE CROSS BLUE SHIELD
2	09600	OTHER	MI	BLUE CROSS/BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346214426
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IRON COUNTY MEDICAL CARE FACILITY

Provider Business Mailing Address
First Line	:	1523 HIGHWAY US 2
Second Line	:
City	:	CRYSTAL FALLS
State	:	MI
Zip	:	49920-9633
Country	:	US
Telephone Number	:	906-875-6671
Fax Number	:	906-875-6573

Provider Business Practice Location Address
First Line	:	1523 HIGHWAY US 2
Second Line	:
City	:	CRYSTAL FALLS
State	:	MI
Zip	:	49920-9633
Country	:	US
Telephone Number	:	906-875-6671
Fax Number	:	906-875-6573

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	ROBERT POSSANZA
Credential	:
Telephone Number	:	906-875-6671

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	01/30/2023

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Directions to “IRON COUNTY MEDICAL CARE FACILITY ” Practice Location

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