| |
427 S. Stephenson Ave, 2nd Floor Iron Mountain MI 49801 | |
(906) 776-4357 | |
Not Available |
Full Name | |
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Speciality | Community/Behavioral Health |
Location | 427 S. Stephenson Ave,, Iron Mountain, Michigan |
Authorized Official Name and Position | Mark R. Young (PRESIDENT) |
Authorized Official Contact | 9067764357 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 1012 Iron Mountain MI 49801-8012 Ph: (906) 776-4357 | 427 S. Stephenson Ave, 2nd Floor Iron Mountain MI 49801 Ph: (906) 776-4357 |
NPI Number | 1770668667 |
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Provider Enumeration Date | 10/26/2006 |
Last Update Date | 11/07/2010 |
Medicare PECOS PAC ID | 3678723798 |
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Medicare Enrollment ID | O20121026000405 |
Identifier | Type | State | Issuer |
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1770668667 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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251S00000X | Community/behavioral Health | (Michigan) | Primary |
Provider Name | Mark R Young |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1114002631 PECOS PAC ID: 8921258047 Enrollment ID: I20121030000183 |
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