MEDICARE: MARATHON HEALTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1508691429
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARATHON HEALTH LLC

Provider Business Mailing Address
First Line	:	10 W MARKET ST STE 2900
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46204-2964
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 W NORTH BLVD STE 202
Second Line	:
City	:	LEESBURG
State	:	FL
Zip	:	34748-5039
Country	:	US
Telephone Number	:	352-320-0160
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JEFF WELLS
Credential	:	MD
Telephone Number	:	802-857-0400

Provider Enumeration Date	:	09/03/2024
Last Update Date	:	09/03/2024

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