Provider Demographics
NPI:1922107655
Name:ASPIRUS KEWEENAW
Entity Type:Organization
Organization Name:ASPIRUS KEWEENAW
Other - Org Name:ASPIRUS KEWEENAW PHARMACY - LAURIUM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR-SYSTEM/REVENUE INTEGRITY
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:A
Authorized Official - Last Name:THUMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-847-0020
Mailing Address - Street 1:205 OSCEOLA ST
Mailing Address - Street 2:
Mailing Address - City:LAURIUM
Mailing Address - State:MI
Mailing Address - Zip Code:49913-2134
Mailing Address - Country:US
Mailing Address - Phone:906-337-6575
Mailing Address - Fax:906-337-6576
Practice Address - Street 1:205 OSCEOLA ST
Practice Address - Street 2:
Practice Address - City:LAURIUM
Practice Address - State:MI
Practice Address - Zip Code:49913-2134
Practice Address - Country:US
Practice Address - Phone:906-337-6575
Practice Address - Fax:906-337-6576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010067593336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3451598Medicaid
MI3451598Medicaid
100564003Medicare ID - Type Unspecified