Provider Demographics
NPI:1417959750
Name:MARQUETTE GENERAL HOSPITAL, INC.
Entity Type:Organization
Organization Name:MARQUETTE GENERAL HOSPITAL, INC.
Other - Org Name:MARQUETTE GENERAL HEALTH SYSTEM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:WORDEN
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:906-225-3450
Mailing Address - Street 1:420 W MAGNETIC ST
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-2711
Mailing Address - Country:US
Mailing Address - Phone:906-225-3406
Mailing Address - Fax:906-225-3094
Practice Address - Street 1:420 W MAGNETIC ST
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-2711
Practice Address - Country:US
Practice Address - Phone:906-225-3406
Practice Address - Fax:906-225-3094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI520050282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIDB4800OtherRAILROAD MEDICARE GROUP#
MI11023100OtherWISCONSIN MEDICAID
MI00002OtherBCBSM HOSPITAL
MI430E26018OtherBLUE SHIELD CRNA GROUP
MI405171154Medicaid
MI404971378Medicaid
MI903292929Medicaid
WI43418700OtherWISC MEDICAID CRNA GROUP
MI301556634Medicaid
MI903292929Medicaid
MI405171154Medicaid
MI230054Medicare Oscar/Certification