Provider Demographics
NPI:1982772398
Name:CHIPPEWA COUNTY WAR MEMORIAL HOSPITAL INC.
Entity Type:Organization
Organization Name:CHIPPEWA COUNTY WAR MEMORIAL HOSPITAL INC.
Other - Org Name:PICKFORD MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:JAHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-635-4460
Mailing Address - Street 1:7742 NORTH M 129
Mailing Address - Street 2:
Mailing Address - City:PICKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49774
Mailing Address - Country:US
Mailing Address - Phone:906-647-2218
Mailing Address - Fax:
Practice Address - Street 1:7742 NORTH M 129
Practice Address - Street 2:
Practice Address - City:PICKFORD
Practice Address - State:MI
Practice Address - Zip Code:49774
Practice Address - Country:US
Practice Address - Phone:906-647-2218
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301057132207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI233952Medicare Oscar/Certification