Healthcare Provider Details

I. General information

NPI: 1093039331
Provider Name (Legal Business Name): MARATHON HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2010
Last Update Date: 03/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 NW 70TH TER
PLANTATION FL
33317-2239
US

IV. Provider business mailing address

354 MOUNTAIN VIEW DR SUITE 300
COLCHESTER VT
05446-5968
US

V. Phone/Fax

Practice location:
  • Phone: 954-513-3530
  • Fax: 954-513-3539
Mailing address:
  • Phone: 802-857-0400
  • Fax: 802-655-3607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: MR. JERRY M FORD
Title or Position: CEO
Credential:
Phone: 802-857-0400