Provider Demographics
NPI:1588654941
Name:MARQUETTE GENERAL HOSPITAL INC
Entity Type:Organization
Organization Name:MARQUETTE GENERAL HOSPITAL INC
Other - Org Name:MARQUETTE GENERAL HOME HEALTH AND HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR OF HOME HEALTH
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARTIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-228-4325
Mailing Address - Street 1:580 W COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-2705
Mailing Address - Country:US
Mailing Address - Phone:906-228-4325
Mailing Address - Fax:906-225-3642
Practice Address - Street 1:580 W COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-2705
Practice Address - Country:US
Practice Address - Phone:906-225-4774
Practice Address - Fax:906-225-3642
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARQUETTE GENERAL HOSPITAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-26
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI26251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4364316OtherCSHCS MICHIGAN MEDICAID
WI41528500Medicaid
MI2883310Medicaid
MI2883310Medicaid