1619020575 NPI number — MARION GENERAL HOSPITAL

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619020575 NPI number — MARION GENERAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARION GENERAL HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FAIRMOUNT MEDICAL ASSOCIATES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619020575
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
330 N WABASH
Provider Second Line Business Mailing Address:
STE G20
Provider Business Mailing Address City Name:
MARION
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46952-2555
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-660-7880
Provider Business Mailing Address Fax Number:
765-382-4490

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
157 W 8TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRMOUNT
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46928-1012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-660-7880
Provider Business Practice Location Address Fax Number:
765-382-4490
Provider Enumeration Date:
01/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HILTON-SIEBERT
Authorized Official First Name:
STEPHANIE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
765-660-7005

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100269250 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com