MEDICARE: MARQUETTE GENERAL HOSPITAL, INC.

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital	520050	MI

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DB4800	OTHER	MI	RAILROAD MEDICARE GROUP#

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	00002	OTHER	MI	BCBSM HOSPITAL
4	430E26018	OTHER	MI	BLUE SHIELD CRNA GROUP
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1417959750
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARQUETTE GENERAL HOSPITAL, INC.

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

Provider Business Practice Location Address
First Line	:	420 W MAGNETIC ST
Second Line	:
City	:	MARQUETTE
State	:	MI
Zip	:	49855-2711
Country	:	US
Telephone Number	:	906-225-3406
Fax Number	:	906-225-3094

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MR. JERRY L WORDEN
Credential	:	CPA
Telephone Number	:	906-225-3450

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	04/17/2009