Provider Demographics
NPI:1609811058
Name:ASPIRUS KEWEENAW
Entity Type:Organization
Organization Name:ASPIRUS KEWEENAW
Other - Org Name:ASPIRUS KEWEENAW MEDICAL ARTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP 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:715-847-2988
Mailing Address - Street 1:301 WEST LAKESHORE DRIVE
Mailing Address - Street 2:
Mailing Address - City:HOUGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:49931-2200
Mailing Address - Country:US
Mailing Address - Phone:906-487-1710
Mailing Address - Fax:906-487-9421
Practice Address - Street 1:301 WEST LAKESHORE DRIVE
Practice Address - Street 2:
Practice Address - City:HOUGHTON
Practice Address - State:MI
Practice Address - Zip Code:49931-2200
Practice Address - Country:US
Practice Address - Phone:906-487-1710
Practice Address - Fax:906-487-9421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080C160340OtherBLUE CROSS & BLUE SHIELD
MI0C16002009Medicare PIN
MI080C160340OtherBLUE CROSS & BLUE SHIELD