Provider Demographics
NPI:1073665279
Name:MARLETTE REGIONAL HOSPITAL
Entity Type:Organization
Organization Name:MARLETTE REGIONAL HOSPITAL
Other - Org Name:MAYVILLE FAMILY HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LIVIERATOS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:989-843-5135
Mailing Address - Street 1:2180 E OHMER RD
Mailing Address - Street 2:
Mailing Address - City:MAYVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48744-9501
Mailing Address - Country:US
Mailing Address - Phone:989-843-5135
Mailing Address - Fax:877-845-1481
Practice Address - Street 1:2180 E OHMER RD
Practice Address - Street 2:
Practice Address - City:MAYVILLE
Practice Address - State:MI
Practice Address - Zip Code:48744-9501
Practice Address - Country:US
Practice Address - Phone:989-843-5135
Practice Address - Fax:989-843-5121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2017-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMO009325261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080G910110OtherBCBSM
MI4266253Medicaid
MIP17072Medicare UPIN
MI4266253Medicaid
MI080G910110OtherBCBSM