Provider Demographics
NPI:1306968391
Name:MARATHON COUNTY
Entity type:Organization
Organization Name:MARATHON COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:L
Authorized Official - Last Name:TYLKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-261-7500
Mailing Address - Street 1:400 E THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-6498
Mailing Address - Country:US
Mailing Address - Phone:715-261-7500
Mailing Address - Fax:715-261-7510
Practice Address - Street 1:400 E THOMAS ST
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-6498
Practice Address - Country:US
Practice Address - Phone:715-261-7500
Practice Address - Fax:715-261-7510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43112300Medicaid