Provider Demographics
NPI:1346214426
Name:IRON COUNTY MEDICAL CARE FACILITY
Entity Type:Organization
Organization Name:IRON COUNTY MEDICAL CARE FACILITY
Other - Org Name:SKYWAY REHAB SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:POSSANZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-875-6671
Mailing Address - Street 1:1523 HIGHWAY US 2
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL FALLS
Mailing Address - State:MI
Mailing Address - Zip Code:49920-9633
Mailing Address - Country:US
Mailing Address - Phone:906-875-6671
Mailing Address - Fax:906-875-6573
Practice Address - Street 1:1523 HIGHWAY US 2
Practice Address - Street 2:
Practice Address - City:CRYSTAL FALLS
Practice Address - State:MI
Practice Address - Zip Code:49920-9633
Practice Address - Country:US
Practice Address - Phone:906-875-6671
Practice Address - Fax:906-875-6573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI368510261QR0401X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI30436OtherBLUE CROSS BLUE SHIELD
MI09600OtherBLUE CROSS/BLUE SHIELD
MI2085043Medicaid
MI234532Medicare Oscar/Certification
MI09600OtherBLUE CROSS/BLUE SHIELD