Healthcare Provider Details

I. General information

NPI: 1316944838
Provider Name (Legal Business Name): MARQUETTE COUNTY MEDICAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 05/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SAGINAW STREET
ISHPEMING MI
49849-2469
US

IV. Provider business mailing address

200 SAGINAW STREET
ISHPEMING MI
49849-2469
US

V. Phone/Fax

Practice location:
  • Phone: 906-485-1061
  • Fax: 906-485-4080
Mailing address:
  • Phone: 906-485-1061
  • Fax: 906-485-4080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number528511
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1070000233
License Number StateMI

VIII. Authorized Official

Name: MR. JEROME D. HUBBARD
Title or Position: ADMINISTRATOR
Credential:
Phone: 906-485-4887