Provider Demographics
NPI:1093734162
Name:COUNTY OF MARQUETTE
Entity Type:Organization
Organization Name:COUNTY OF MARQUETTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR HEALTH OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCARTNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-297-9116
Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:77 WEST PARK STREET
Mailing Address - City:MONTELLO
Mailing Address - State:WI
Mailing Address - Zip Code:53949-0129
Mailing Address - Country:US
Mailing Address - Phone:608-297-3001
Mailing Address - Fax:608-297-7606
Practice Address - Street 1:480 UNDERWOOD AVENUE
Practice Address - Street 2:
Practice Address - City:MONTELLO
Practice Address - State:WI
Practice Address - Zip Code:53949-0181
Practice Address - Country:US
Practice Address - Phone:608-297-3135
Practice Address - Fax:608-297-8923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41850900Medicaid
WI41850900Medicaid
WI85253Medicare PIN