Healthcare Provider Details

I. General information

NPI: 1144525213
Provider Name (Legal Business Name): MARQUTTE GENERA HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2011
Last Update Date: 01/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3139 REVERE DR
SAGINAW MI
48603-1642
US

IV. Provider business mailing address

420 W MAGNETIC ST
MARQUETTE MI
49855-2711
US

V. Phone/Fax

Practice location:
  • Phone: 989-332-6020
  • Fax: 989-791-2007
Mailing address:
  • Phone: 906-225-3595
  • Fax: 877-775-5759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704247120
License Number StateMI

VIII. Authorized Official

Name: MR. JERRY L WARDEN SR.
Title or Position: VP/CFO
Credential:
Phone: 906-228-9440