Provider Demographics
NPI:1740692474
Name:UPPER PENINSULA ASSOCIATION OF RURAL HEALTH SERVICES, INC
Entity type:Organization
Organization Name:UPPER PENINSULA ASSOCIATION OF RURAL HEALTH SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:JAKSIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-228-3613
Mailing Address - Street 1:220 W WASHINGTON ST
Mailing Address - Street 2:SUITE 430
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-4359
Mailing Address - Country:US
Mailing Address - Phone:906-228-3613
Mailing Address - Fax:906-228-3656
Practice Address - Street 1:220 W WASHINGTON ST
Practice Address - Street 2:SUITE 430
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4359
Practice Address - Country:US
Practice Address - Phone:906-228-3613
Practice Address - Fax:906-228-3656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-29
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty