Provider Demographics
NPI:1508081423
Name:MARATHON COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:MARATHON COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN. OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SEASON
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-261-1941
Mailing Address - Street 1:1000 LAKE VIEW DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-6781
Mailing Address - Country:US
Mailing Address - Phone:715-261-1900
Mailing Address - Fax:715-261-1901
Practice Address - Street 1:1000 LAKE VIEW DR
Practice Address - Street 2:SUITE 100
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-6781
Practice Address - Country:US
Practice Address - Phone:715-261-1900
Practice Address - Fax:715-261-1901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41852300Medicaid
WI43084400Medicaid
WI4400900Medicaid