MEDICARE: IOSCO 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	314000000X	Skilled Nursing Facility	414350	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760470017
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IOSCO MEDICAL CARE FACILITY

Provider Business Mailing Address
First Line	:	1201 HARRIS AVE
Second Line	:
City	:	TAWAS CITY
State	:	MI
Zip	:	48763-9680
Country	:	US
Telephone Number	:	989-362-4424
Fax Number	:	989-362-4904

Provider Business Practice Location Address
First Line	:	1201 HARRIS AVE
Second Line	:
City	:	TAWAS CITY
State	:	MI
Zip	:	48763-9680
Country	:	US
Telephone Number	:	989-362-4424
Fax Number	:	989-362-4904

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. JON R. LOOK
Credential	:	NHA
Telephone Number	:	989-362-4424

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	05/15/2013

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Directions to “IOSCO MEDICAL CARE FACILITY ” Practice Location

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