1417959750 NPI number — MARQUETTE GENERAL HOSPITAL, INC.

Table of content: (NPI 1417959750)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417959750 NPI number — MARQUETTE GENERAL HOSPITAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARQUETTE GENERAL HOSPITAL, INC.
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:
MARQUETTE GENERAL HEALTH SYSTEM
Provider Other Organization Name Type Code:
3
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:
1417959750
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
420 W MAGNETIC ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARQUETTE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49855-2711
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
906-225-3406
Provider Business Mailing Address Fax Number:
906-225-3094

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
420 W MAGNETIC ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARQUETTE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49855-2711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
906-225-3406
Provider Business Practice Location Address Fax Number:
906-225-3094
Provider Enumeration Date:
06/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WORDEN
Authorized Official First Name:
JERRY
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
906-225-3450

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  520050 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DB4800 . This is a "RAILROAD MEDICARE GROUP#" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 11023100 . This is a "WISCONSIN MEDICAID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 00002 . This is a "BCBSM HOSPITAL" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 430E26018 . This is a "BLUE SHIELD CRNA GROUP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 405171154 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 404971378 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 903292929 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 43418700 . This is a "WISC MEDICAID CRNA GROUP" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 301556634 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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