Provider Demographics
NPI:1205999653
Name:COUNTY OF MARINETTE
Entity type:Organization
Organization Name:COUNTY OF MARINETTE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTH AND HUMAN SERVICES DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:GERALD
Authorized Official - Last Name:ELSNER
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:715-732-7700
Mailing Address - Street 1:2500 HALL AVENUE
Mailing Address - Street 2:SUITE C
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143
Mailing Address - Country:US
Mailing Address - Phone:715-732-7670
Mailing Address - Fax:715-732-7646
Practice Address - Street 1:2500 HALL AVENUE
Practice Address - Street 2:SUITE C
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143
Practice Address - Country:US
Practice Address - Phone:715-732-7670
Practice Address - Fax:715-732-7646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000083758OtherMEDICARE PTAN