Healthcare Provider Details

I. General information

NPI: 1790743839
Provider Name (Legal Business Name): MARQUETTE GENERAL HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 11/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 W FAIR AVE SUITE 35
MARQUETTE MI
49855-2675
US

IV. Provider business mailing address

PO BOX 220
MARQUETTE MI
49855-0220
US

V. Phone/Fax

Practice location:
  • Phone: 906-225-4555
  • Fax: 906-225-4554
Mailing address:
  • Phone: 906-225-4535
  • Fax: 906-225-4554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM NEMACHECK
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 906-225-4821