1871797571 NPI number — MARLETTE REGIONAL HOSPITAL

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871797571 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:
Provider Other Organization Name Type Code:
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:
1871797571
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/16/2018
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:
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:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4000 HURON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH BRANCH
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-688-3048
Provider Business Practice Location Address Fax Number:
877-848-0921
Provider Enumeration Date:
06/14/2007

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0D410160 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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