1073698981 NPI number — MARLETTE REGIONAL HOSPITAL

Table of content: (NPI 1073698981)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073698981 NPI number — MARLETTE REGIONAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARLETTE REGIONAL HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MARLETTE REGIONAL HOSPITAL CRNA GROUP
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073698981
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2770 MAIN ST
Provider Second Line Business Mailing Address:
PO BOX 307
Provider Business Mailing Address City Name:
MARLETTE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48453-1141
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-635-4000
Provider Business Mailing Address Fax Number:
989-635-4056

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2770 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARLETTE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48453-1141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-635-4000
Provider Business Practice Location Address Fax Number:
989-635-4056
Provider Enumeration Date:
10/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BABCOCK
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
GUY
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
989-635-4002

Provider Taxonomy Codes

  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0G676020 . This is a "BLUE CROSS/SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0994757 . This is a "HEALTHPLUS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com