Provider Demographics
NPI:1316944838
Name:MARQUETTE COUNTY MEDICAL CARE
Entity type:Organization
Organization Name:MARQUETTE COUNTY MEDICAL CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:D
Authorized Official - Last Name:HUBBARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-485-4887
Mailing Address - Street 1:200 SAGINAW STREET
Mailing Address - Street 2:
Mailing Address - City:ISHPEMING
Mailing Address - State:MI
Mailing Address - Zip Code:49849-2469
Mailing Address - Country:US
Mailing Address - Phone:906-485-1061
Mailing Address - Fax:906-485-4080
Practice Address - Street 1:200 SAGINAW STREET
Practice Address - Street 2:
Practice Address - City:ISHPEMING
Practice Address - State:MI
Practice Address - Zip Code:49849-2469
Practice Address - Country:US
Practice Address - Phone:906-485-1061
Practice Address - Fax:906-485-4080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI528511314000000X
MI1070000233314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI09643OtherBLUE CROSS BLUE SHIELD
MI1230573Medicaid
MI09643OtherBLUE CROSS BLUE SHIELD