Provider Demographics
NPI:1770687931
Name:BARAGA COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:BARAGA COUNTY MEMORIAL HOSPITAL
Other - Org Name:BARAGA COUNTY MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:PEPIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:906-524-3435
Mailing Address - Street 1:510 MEMORIAL ST
Mailing Address - Street 2:
Mailing Address - City:LANSE
Mailing Address - State:MI
Mailing Address - Zip Code:49946-1138
Mailing Address - Country:US
Mailing Address - Phone:906-524-7156
Mailing Address - Fax:
Practice Address - Street 1:510 MEMORIAL ST
Practice Address - Street 2:
Practice Address - City:LANSE
Practice Address - State:MI
Practice Address - Zip Code:49946-1138
Practice Address - Country:US
Practice Address - Phone:906-524-7156
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3205487Medicaid
MI540Z702510OtherBLUE CROSS
=========003OtherTRICARE
=========003OtherTRICARE
MI3205487Medicaid