Healthcare Provider Details

I. General information

NPI: 1306004155
Provider Name (Legal Business Name): MARQUETTE GENERAL HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2530 1ST AVE N
ESCANABA MI
49829-1390
US

IV. Provider business mailing address

PO BOX 220
MARQUETTE MI
49855-0220
US

V. Phone/Fax

Practice location:
  • Phone: 906-225-3674
  • Fax:
Mailing address:
  • Phone: 906-225-3630
  • Fax: 906-225-4537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: A. GARY MULLER
Title or Position: CEO
Credential:
Phone: 906-225-3674