Provider Demographics
NPI:1306841317
Name:COUNTY OF MARQUETTE
Entity Type:Organization
Organization Name:COUNTY OF MARQUETTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF EMS
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOUSLET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-297-3125
Mailing Address - Street 1:480 UNDERWOOD AVE
Mailing Address - Street 2:PO BOX 181
Mailing Address - City:MONTELLO
Mailing Address - State:WI
Mailing Address - Zip Code:53949-9248
Mailing Address - Country:US
Mailing Address - Phone:608-297-3125
Mailing Address - Fax:608-297-9176
Practice Address - Street 1:480 UNDERWOOD AVE
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:608-297-3125
Practice Address - Fax:608-297-9176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60009933416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41328900Medicaid
WI41328900Medicaid