Provider Demographics
NPI:1679804058
Name:UPPER PENINSULA ASSOC. OF RURAL HEALTH SERVICES INC.
Entity Type:Organization
Organization Name:UPPER PENINSULA ASSOC. OF RURAL HEALTH SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAKSIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-228-3655
Mailing Address - Street 1:6150 GREELEY AVE NE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-8061
Mailing Address - Country:US
Mailing Address - Phone:616-204-9638
Mailing Address - Fax:
Practice Address - Street 1:220 W WASHINGTON ST STE 430
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4346
Practice Address - Country:US
Practice Address - Phone:906-228-3655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-25
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704142802261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health