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1721 S Stephenson Ave Iron Mountain MI 49801-3637 | |
(906) 774-1313 | |
(906) 776-5639 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1721 S Stephenson Ave, Iron Mountain, Michigan |
Authorized Official Name and Position | Charles Nelson (CHIEF EXECUTIVE OFFICER) |
Authorized Official Contact | 9067741313 |
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 549 Iron Mountain MI 49801-0549 Ph: (906) 774-1313 | 1721 S Stephenson Ave Iron Mountain MI 49801-3637 Ph: (906) 774-1313 |
NPI Number | 1891723128 |
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Provider Enumeration Date | 06/28/2006 |
Last Update Date | 11/26/2019 |
Medicare PECOS PAC ID | 6800784943 |
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Medicare Enrollment ID | O20100325000785 |
Identifier | Type | State | Issuer |
---|---|---|---|
1891723128 | NPI | - | NPPES |
43058200 | Medicaid | WI | |
16126 | Other | MI | BCBS FACILITY CODE RHC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Secondary |
261QU0200X | Clinic/center - Urgent Care | (* (Not Available)) | Primary |
Indigo Hospital Medicine - Iron Mountain Plc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1721 S Stephenson Ave, Iron Mountain, MI 49801 Phone: 906-776-5415 Fax: 906-776-5402 | |