Provider Demographics
NPI:1326115569
Name:ASPIRUS KEWEENAW
Entity type:Organization
Organization Name:ASPIRUS KEWEENAW
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SVP & CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-847-2526
Mailing Address - Street 1:205 OSCEOLA STREET
Mailing Address - Street 2:
Mailing Address - City:LAURIUM
Mailing Address - State:MI
Mailing Address - Zip Code:49913-2134
Mailing Address - Country:US
Mailing Address - Phone:906-337-6500
Mailing Address - Fax:906-337-6597
Practice Address - Street 1:205 OSCEOLA STREET
Practice Address - Street 2:
Practice Address - City:LAURIUM
Practice Address - State:MI
Practice Address - Zip Code:49913-2134
Practice Address - Country:US
Practice Address - Phone:906-337-6500
Practice Address - Fax:906-337-6597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI231319282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1556607Medicaid
MI00108OtherBLUE CROSS OF MICHIGAN
MI5170264Medicaid
MI00108OtherBLUE CROSS OF MICHIGAN