Provider Demographics
NPI:1346333226
Name:COUNTY OF MARQUETTE
Entity Type:Organization
Organization Name:COUNTY OF MARQUETTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:J
Authorized Official - Last Name:BENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-315-2640
Mailing Address - Street 1:184 US HIGHWAY 41 E
Mailing Address - Street 2:
Mailing Address - City:NEGAUNEE
Mailing Address - State:MI
Mailing Address - Zip Code:49866-9606
Mailing Address - Country:US
Mailing Address - Phone:906-475-9977
Mailing Address - Fax:906-475-9312
Practice Address - Street 1:184 US HIGHWAY 41 E
Practice Address - Street 2:
Practice Address - City:NEGAUNEE
Practice Address - State:MI
Practice Address - Zip Code:49866-9606
Practice Address - Country:US
Practice Address - Phone:906-475-9977
Practice Address - Fax:906-475-9312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI08-0E2-10840OtherBCBSMEDICAL PROVIDER
MI775325081Medicaid
MI235100662Medicaid
MI775325107Medicaid
MI772671990Medicaid
MI0N92320Medicare ID - Type UnspecifiedMEDICARE PART B
MI772671990Medicaid