Provider Demographics
NPI:1487758595
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:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:ZWICKEY
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
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:906-524-3300
Mailing Address - Fax:906-524-6218
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:906-524-3300
Practice Address - Fax:906-524-6218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301039795207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0Z71002OtherBCBS OF MICHIGAN GROUP
MI=========OtherGROUP TAX ID NUMBER
MIDC7309Medicare PIN
MI0Z76002Medicare PIN