Provider Demographics
NPI:1558479824
Name:BARAGA COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:BARAGA COUNTY MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARQUERITE
Authorized Official - Middle Name:
Authorized Official - Last Name:HALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-524-3300
Mailing Address - Street 1:18341 US HIGHWAY 41
Mailing Address - Street 2:
Mailing Address - City:L'ANSE
Mailing Address - State:MI
Mailing Address - Zip Code:49946
Mailing Address - Country:US
Mailing Address - Phone:906-524-3300
Mailing Address - Fax:905-524-3405
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:906-524-3405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2017-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI070020282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI231307OtherMEDICARE PART A
MIP00204OtherBLUE CROSS NETWORK ID
MI00204OtherBLUE CROSS
MI1555305Medicaid
MI5170086Medicaid
MI1555305Medicaid