Healthcare Provider Details

I. General information

NPI: 1093734162
Provider Name (Legal Business Name): COUNTY OF MARQUETTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 08/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 UNDERWOOD AVENUE
MONTELLO WI
53949-0181
US

IV. Provider business mailing address

PO BOX 129 77 WEST PARK STREET
MONTELLO WI
53949-0129
US

V. Phone/Fax

Practice location:
  • Phone: 608-297-3135
  • Fax: 608-297-8923
Mailing address:
  • Phone: 608-297-3001
  • Fax: 608-297-7606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. SUZANNE MCCARTNEY
Title or Position: DIRECTOR HEALTH OFFICER
Credential:
Phone: 608-297-9116