MEDICARE: MARQUETTE TOWNSHIP BOARD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	341600000X	Ambulance

General Provider Information

NPI Number	:	1497270391
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARQUETTE TOWNSHIP BOARD

Provider Business Mailing Address
First Line	:	1000 COMMERCE DR
Second Line	:
City	:	MARQUETTE
State	:	MI
Zip	:	49855-8694
Country	:	US
Telephone Number	:	906-228-4296
Fax Number	:	906-228-4297

Provider Business Practice Location Address
First Line	:	2801 VENTURE DR
Second Line	:
City	:	MARQUETTE
State	:	MI
Zip	:	49855-8633
Country	:	US
Telephone Number	:	906-228-4296
Fax Number	:	906-228-4297

Authorized Official
Title or Position	:	ASST CHIEF
Name	:	MR. DANIEL SHANAHAN
Credential	:
Telephone Number	:	906-228-4296

Provider Enumeration Date	:	08/11/2017
Last Update Date	:	08/11/2017

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Directions to “MARQUETTE TOWNSHIP BOARD ” Practice Location

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