Provider Demographics
NPI:1922065515
Name:MARQUETTE GENERAL HOSPITAL,INC.
Entity Type:Organization
Organization Name:MARQUETTE GENERAL HOSPITAL,INC.
Other - Org Name:MARQUETTE GENERAL NEUROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ARNOLD
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:MULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-225-4821
Mailing Address - Street 1:2837 US 41 WEST
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-0220
Mailing Address - Country:US
Mailing Address - Phone:906-225-3964
Mailing Address - Fax:906-226-3875
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:906-225-3993
Practice Address - Fax:906-226-3875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-27
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E26028OtherBCBSM GROUP
MI=========002OtherTRICARE GROUP
CN8789Medicare PIN
C31351Medicare PIN
MI0E26028Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
MI=========002OtherTRICARE GROUP
CI0319Medicare PIN
CA1145Medicare PIN