Healthcare Provider Details

I. General information

NPI: 1881600641
Provider Name (Legal Business Name): MARILYN'S MEDICAL FREEDOM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 05/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4860 OLD MAYFIELD RD
PADUCAH KY
42003-9074
US

IV. Provider business mailing address

4860 OLD MAYFIELD RD
PADUCAH KY
42003-9074
US

V. Phone/Fax

Practice location:
  • Phone: 270-534-9713
  • Fax: 270-554-4643
Mailing address:
  • Phone: 270-534-9713
  • Fax: 270-554-4643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MS. JENNIFER M FOX
Title or Position: OFFICE MANAGER
Credential:
Phone: 270-534-9713