1710925045 NPI number — MARION INDEPENDENT PHYSICIANS ASSOCIATION, LLC

Table of content: (NPI 1710925045)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710925045 NPI number — MARION INDEPENDENT PHYSICIANS ASSOCIATION, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARION INDEPENDENT PHYSICIANS ASSOCIATION, LLC
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:
1710925045
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 887
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARION
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43301-0887
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-223-3496
Provider Business Mailing Address Fax Number:
740-383-6463

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30D EXECUTIVE DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARION
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43302-6310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-387-7793
Provider Business Practice Location Address Fax Number:
740-387-7795
Provider Enumeration Date:
06/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RAVI
Authorized Official First Name:
SRINIVAS
Authorized Official Middle Name:
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
740-387-7793

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • 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" .
  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2105251 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2105242 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2105288 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2105359 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2105519 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2105386 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2105224 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2105322 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2105331 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2104136 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2105411 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2105475 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2104127 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2105279 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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