Healthcare Provider Details

I. General information

NPI: 1356318299
Provider Name (Legal Business Name): CMS MARATHON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10015 OVERSEAS HIGHWAY
MARATHON FL
33050
US

IV. Provider business mailing address

10015 OVERSEAS HIGHWAY
MARATHON FL
33050
US

V. Phone/Fax

Practice location:
  • Phone: 305-289-2779
  • Fax: 305-289-2781
Mailing address:
  • Phone: 305-289-2779
  • Fax: 305-289-2781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateFL

VIII. Authorized Official

Name: MRS. CARMEN LOPEZ
Title or Position: PROGRAM ADMINISTRATOR
Credential:
Phone: 305-349-1330