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General NPI Number Information
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NPI Number | 1316983273
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Entity Type | Organization
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Legal Business Name | CITY OF MARIETTA
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Dates
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Enumeration Date | 06/21/2006
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Last Update Date | 11/24/2014
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Provider Practice Location Address
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Address Line | 304 PUTNAM ST
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City | MARIETTA
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State | OH
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Zip | 45750-3022
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Country | US
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Telephone | 740-373-0611
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Fax | 740-376-2008
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Provider Business Mailing Address
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Address Line | 304 PUTNAM ST
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City | MARIETTA
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State | OH
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Zip | 45750-3022
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Country | US
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Telephone | 740-373-0611
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Fax | 740-376-2008
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Authorized Official
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Title or Position | HEALTH COMMISSIONER
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Name | DR. MICHAEL K BROCKETT
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Credential | M.D.
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Telephone | 740-373-0611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number | 35043094B
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License Number State | OH
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