Provider Demographics
NPI:1104195601
Name:UPPER PENINSULA MANAGED CARE, LLC
Entity Type:Organization
Organization Name:UPPER PENINSULA MANAGED CARE, LLC
Other - Org Name:UP HEALTH GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-225-7500
Mailing Address - Street 1:228 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-4330
Mailing Address - Country:US
Mailing Address - Phone:906-225-7500
Mailing Address - Fax:
Practice Address - Street 1:228 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4330
Practice Address - Country:US
Practice Address - Phone:906-225-7500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704253641251B00000X
MI4704191191251B00000X
MI4704112142251B00000X
MI4704192981251B00000X
MI4704122245251B00000X
MI4704114122251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management