Provider Demographics
NPI:1700980968
Name:BARAGA COUNTY MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:BARAGA COUNTY MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:ZWICKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-524-3321
Mailing Address - Street 1:18341 US HIGHWAY 41
Mailing Address - Street 2:
Mailing Address - City:LANSE
Mailing Address - State:MI
Mailing Address - Zip Code:49946-8024
Mailing Address - Country:US
Mailing Address - Phone:906-524-6118
Mailing Address - Fax:906-524-5126
Practice Address - Street 1:18341 US HIGHWAY 41
Practice Address - Street 2:
Practice Address - City:LANSE
Practice Address - State:MI
Practice Address - Zip Code:49946-8024
Practice Address - Country:US
Practice Address - Phone:906-524-6118
Practice Address - Fax:906-524-5126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0Z71004OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI0Z71003OtherBCBS GROUP ID
MI0Z71004OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI=========OtherGROUP TAX ID NUMBER
MI0N95910Medicare PIN
MI0Z71003OtherBCBS GROUP ID