1861850315 NPI number — MARATHON MEDICAL SERVICE

Table of content: (NPI 1861850315)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861850315 NPI number — MARATHON MEDICAL SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARATHON MEDICAL SERVICE
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:
1861850315
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4325 LAUREL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANCHORAGE
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99508-5364
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-250-9239
Provider Business Mailing Address Fax Number:
907-274-9238

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4325 LAUREL STREET
Provider Second Line Business Practice Location Address:
SUITE 240
Provider Business Practice Location Address City Name:
ANCHORAGE
Provider Business Practice Location Address State Name:
ALASKA
Provider Business Practice Location Address Postal Code:
99508
Provider Business Practice Location Address Country Code:
UM
Provider Business Practice Location Address Telephone Number:
907-250-9239
Provider Business Practice Location Address Fax Number:
907-274-9238
Provider Enumeration Date:
01/28/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
APPLEBURY
Authorized Official First Name:
RYAN
Authorized Official Middle Name:
JAY
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
907-250-9239

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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