Provider Demographics
NPI:1851409643
Name:BARAGA COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:BARAGA COUNTY MEMORIAL HOSPITAL
Other - Org Name:BCMH PHYSICIAN GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-524-3320
Mailing Address - Street 1:18341 US HIGHWAY 41
Mailing Address - Street 2:
Mailing Address - City:LANSE
Mailing Address - State:MI
Mailing Address - Zip Code:49946-8024
Mailing Address - Country:US
Mailing Address - Phone:906-524-6118
Mailing Address - Fax:906-524-6218
Practice Address - Street 1:18341 US HIGHWAY 41
Practice Address - Street 2:
Practice Address - City:LANSE
Practice Address - State:MI
Practice Address - Zip Code:49946-8024
Practice Address - Country:US
Practice Address - Phone:906-524-6118
Practice Address - Fax:906-524-6218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0Z71004OtherBCBS OF MI GROUP
MI1841555430OtherMEDICAID RHC NUMBER
MI268646OtherRHC MEDICARE NUMBER
MI=========OtherGROUP TAX ID NUMBER
MI=========OtherGROUP TAX ID NUMBER
MI0Z71004OtherBCBS OF MI GROUP