Provider Demographics
NPI:1598818403
Name:ASPIRUS ONTONAGON HOSPITAL, INC.
Entity Type:Organization
Organization Name:ASPIRUS ONTONAGON HOSPITAL, INC.
Other - Org Name:ONTONAGON MEMORIAL HOSPITAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VP OF REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:PECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-847-2000
Mailing Address - Street 1:29980 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1299
Mailing Address - Country:US
Mailing Address - Phone:715-847-2304
Mailing Address - Fax:
Practice Address - Street 1:601 S 7TH ST
Practice Address - Street 2:
Practice Address - City:ONTONAGON
Practice Address - State:MI
Practice Address - Zip Code:49953-1448
Practice Address - Country:US
Practice Address - Phone:906-884-8000
Practice Address - Fax:906-884-4384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI660020282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI231309Medicare Oscar/Certification