MEDICARE: MARION WOMEN'S HEALTH CENTER INC

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	261QA1903X	Ambulatory Surgical Clinic/Center
2	174400000X	Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770616963
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARION WOMEN'S HEALTH CENTER INC

Provider Business Mailing Address
First Line	:	960 S PROSPECT ST
Second Line	:
City	:	MARION
State	:	OH
Zip	:	43302-6225
Country	:	US
Telephone Number	:	740-383-2776
Fax Number	:	740-383-2978

Provider Business Practice Location Address
First Line	:	960 S PROSPECT ST
Second Line	:
City	:	MARION
State	:	OH
Zip	:	43302-6225
Country	:	US
Telephone Number	:	740-383-2776
Fax Number	:	740-383-2978

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JAYBALAN R MOODLEY
Credential	:	MD
Telephone Number	:	740-383-2776

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	05/29/2014

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