1750463717 NPI number — MARIETTA HEALTH CARE SYSTEMS, INC.

Table of content: (NPI 1750463717)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750463717 NPI number — MARIETTA HEALTH CARE SYSTEMS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARIETTA HEALTH CARE SYSTEMS, INC.
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:
PHYSICIANS CARE OF MARIETTA
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:
1750463717
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
311 LL PUTNAM STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARIETTA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45750-3021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-373-1449
Provider Business Mailing Address Fax Number:
740-373-4063

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 PIKE ST
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
MARIETTA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45750-3507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-373-1449
Provider Business Practice Location Address Fax Number:
740-373-4063
Provider Enumeration Date:
10/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DENNIS
Authorized Official First Name:
LLOYD
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
740-373-1449

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 9280589 . This is a "OH MEDICARE LOCATION ID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 9280585 . This is a "OH MEDICARE LOCATION ID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 9280587 . This is a "OH MEDICARE LOCATION ID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 9280586 . This is a "OH MEDICARE LOCATION ID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 9280581 . This is a "OH MEDICARE LOCATION ID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: LO230931 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0009922000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6703032000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9280582 . This is a "OH MEDICARE LOCATION ID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 9280588 . This is a "OH MEDICARE LOCATION ID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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