NPIMap

Organization Active NPI

Marlette Regional Hospital

  • Rural Health Clinic/Center
  • Brown City, MI
National Provider Identifier
1376695205
Registry record updated Sep 21, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
MO009325 Issued in MI
Legal business name
MARLETTE REGIONAL HOSPITAL
Practice address
4472 Main St
Brown City, MI 48416-7908
Phone
(810) 346-2751
Fax
(810) 346-3238
NPI assigned
Jan 18, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Daniel Kulick, D.O.NPI 1720206600
Title
Medical Director
Phone
(810) 346-2751

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X MO009325 MI Primary

Addresses

Primary practice location

4472 Main St
Brown City, MI 48416-7908

Mailing address

4472 Main St
Brown City, MI 48416-7908
Phone (810) 346-2751

Other identifiers 2

IdentifierTypeStateIssuer
2862561MedicaidMI
010G664991OtherMIBCBSM

Other names 1

  • Family Healthcare of Brown City Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100817000288 MI Part A Provider - Rural Health Clinic 3971408121 Practice locations: Brown City, MI

Rural health clinic certification: CCN 238577

Legal name
MARLETTE REGIONAL HOSPITAL
Doing business as
FAMILY HEALTHCARE OF BROWN CITY
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 17, 2002
Last certification
Mar 27, 2024
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
4472 Main St
Brown City, MI 48416-7908
Related CCNs
231330

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 9

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D0372788Family Healthcare of Brown City4472 Main Street, Brown City, MI 48416Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Marlette Commumity Hosp17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

Organizations that report the same tax identification number in the National Provider Directory.

View all 16

Ownership & related parties

All disclosed owners & managing parties 16

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Carol L Starling Individual Corporate DirectorBoard Member Jan 1, 2024
Faith Ann Fahrner Individual Corporate DirectorBoard Member Jan 1, 2024
Bluewater Healthcare Network Organization, Sandusky, MI Corporation Operational/Managerial Control Dec 28, 2012
Patrick D Curtis Individual Corporate DirectorBoard Member Jan 1, 2024
Kimberly Gentner Individual Corporate OfficerCfo Jan 1, 2024
W-2 Managing EmployeeAd; Jan 1, 2024
Steven Ellis Individual Corporate DirectorBoard Member Jan 1, 2024
Victoria Meiburg Individual Corporate OfficerBoard Member May 10, 2022
Gail Ann Denton Individual Corporate DirectorVice Chairman May 9, 2016
Judy K Brown Individual Corporate DirectorBoard Member Jan 1, 2024
Angela McConnachie Individual Corporate Director Jan 1, 2023
W-2 Managing Employee Jan 1, 2023
Scott Orr Individual Corporate Director Aug 2, 2010
Paul Rohling Individual Corporate DirectorBoard Member Jan 1, 2024
Sarah Kinel Individual W-2 Managing EmployeeProvider Enrollment Jan 1, 2024
Andrew Joseph Daniels Individual Corporate OfficerCeo Jan 1, 2024
W-2 Managing EmployeeAd; Jan 1, 2024
Erik Tamlyn Individual Corporate DirectorBoard Member Jan 1, 2024
David Messing Individual Corporate DirectorChairman Oct 9, 2018

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 5

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 32

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 32

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1505952000000",
    "number": "1376695205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4472 MAIN ST",
            "city": "BROWN CITY",
            "state": "MI",
            "postal_code": "484167908",
            "telephone_number": "810-346-2751",
            "fax_number": "810-346-3238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4472 MAIN ST",
            "city": "BROWN CITY",
            "state": "MI",
            "postal_code": "484167908",
            "telephone_number": "810-346-2751",
            "fax_number": "810-346-3238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARLETTE REGIONAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-18",
        "last_updated": "2017-09-21",
        "status": "A",
        "authorized_official_last_name": "KULICK",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "810-346-2751",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "MI",
            "license": "MO009325",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2862561",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "010G664991",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Healthcare of Brown City",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brown City, MI

Sources for this page

Verify at the official NPI Registry.