Provider Demographics
NPI:1346325214
Name:MARLETTE REGIONAL HOSPITAL
Entity Type:Organization
Organization Name:MARLETTE REGIONAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCONNACHIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-635-4000
Mailing Address - Street 1:2770 MAIN ST
Mailing Address - Street 2:PO BOX 307
Mailing Address - City:MARLETTE
Mailing Address - State:MI
Mailing Address - Zip Code:48453-1141
Mailing Address - Country:US
Mailing Address - Phone:989-635-4000
Mailing Address - Fax:989-635-4206
Practice Address - Street 1:2770 MAIN ST
Practice Address - Street 2:
Practice Address - City:MARLETTE
Practice Address - State:MI
Practice Address - Zip Code:48453-1141
Practice Address - Country:US
Practice Address - Phone:989-635-4000
Practice Address - Fax:989-635-4206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI00002770OtherHEALTHPLUS
MI301555735Medicaid
MI118443OtherGREAT LAKES HEALTH PLAN
MI182769979Medicaid
MI404971340Medicaid
MA00055OtherBLUE CROSS PROVIDER NUMBE
MI405171145Medicaid
MI405171145Medicaid