1275762163 NPI number — MARATHON HEALTH CARE SERVICES OF FLORIDA PA

Table of content: (NPI 1275762163)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275762163 NPI number — MARATHON HEALTH CARE SERVICES OF FLORIDA PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARATHON HEALTH CARE SERVICES OF FLORIDA PA
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:
1275762163
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
354 MOUNTAIN VIEW DR
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
COLCHESTER
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05446-5968
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-857-0400
Provider Business Mailing Address Fax Number:
805-655-3607

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8125 HIGHWOODS PALM WAY
Provider Second Line Business Practice Location Address:
C/O SYNIVERSE
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33647-1776
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-637-5700
Provider Business Practice Location Address Fax Number:
813-637-5931
Provider Enumeration Date:
07/13/2009

Additional Information

Authorized Official

Authorized Official Last Name:
ROSS
Authorized Official First Name:
ASHLEY
Authorized Official Middle Name:
CARMEL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
813-637-5700

Provider Taxonomy Codes

  • Taxonomy code: 332900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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