1003838442 NPI number — MARCELIN MEDICAL CENTER

Table of content: (NPI 1003838442)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003838442 NPI number — MARCELIN MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARCELIN MEDICAL CENTER
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:
Provider Other Organization Name Type Code:
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:
1003838442
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
137 BAKER SREET
Provider Second Line Business Mailing Address:
PO BOX 958
Provider Business Mailing Address City Name:
EMPORIA
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23847
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-336-9811
Provider Business Mailing Address Fax Number:
434-336-0082

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
137 BAKER SREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EMPORIA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23847
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-336-9811
Provider Business Practice Location Address Fax Number:
434-336-0082
Provider Enumeration Date:
07/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MARCELIN
Authorized Official First Name:
FITZGERALD
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSCIAN/CEO
Authorized Official Telephone Number:
434-336-9811

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  0101231381 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 005861128 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 89065FC , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com