1801370614 NPI number — STEVEN MARRINSON PHD PC

Table of content: (NPI 1801370614)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801370614 NPI number — STEVEN MARRINSON PHD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEVEN MARRINSON PHD PC
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:
1801370614
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6 TALLULLAH CIRCLE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VALDOSTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-717-7041
Provider Business Mailing Address Fax Number:
678-317-9051

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7170 E TIERRA BUENA LANE
Provider Second Line Business Practice Location Address:
424
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-717-7041
Provider Business Practice Location Address Fax Number:
678-317-9051
Provider Enumeration Date:
09/18/2018

Additional Information

Authorized Official

Authorized Official Last Name:
MARRINSON
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
404-849-9002

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 097946 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4744 . This is a "LICENSE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com