Healthcare Provider Details

I. General information

NPI: 1881609493
Provider Name (Legal Business Name): MARLETTE REGIONAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 02/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2770 MAIN ST
MARLETTE MI
48453-1141
US

IV. Provider business mailing address

2770 MAIN ST
MARLETTE MI
48453-1141
US

V. Phone/Fax

Practice location:
  • Phone: 989-635-4132
  • Fax: 989-635-4057
Mailing address:
  • Phone: 989-635-4132
  • Fax: 989-635-4057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number5301002378
License Number StateMI

VIII. Authorized Official

Name: LEONARD LIGESKI
Title or Position: PHARMACY DIRECTOR
Credential: BS
Phone: 989-635-4125