Provider Demographics
NPI:1225203284
Name:ASPIRUS IRON RIVER HOSPITAL & CLINICS, INC.
Entity Type:Organization
Organization Name:ASPIRUS IRON RIVER HOSPITAL & CLINICS, INC.
Other - Org Name:ASPIRUS IRON RIVER HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:E
Authorized Official - Last Name:DOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-265-0436
Mailing Address - Street 1:1400 WEST ICE LAKE ROAD
Mailing Address - Street 2:
Mailing Address - City:IRON RIVER
Mailing Address - State:MI
Mailing Address - Zip Code:49935
Mailing Address - Country:US
Mailing Address - Phone:906-265-6121
Mailing Address - Fax:
Practice Address - Street 1:1400 WEST ICE LAKE ROAD
Practice Address - Street 2:
Practice Address - City:IRON RIVER
Practice Address - State:MI
Practice Address - Zip Code:49935
Practice Address - Country:US
Practice Address - Phone:906-265-6121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI430C610010OtherBCBS OF MI
OM31750028Medicare Oscar/Certification
0M37820Medicare PIN