Healthcare Provider Details

I. General information

NPI: 1023451143
Provider Name (Legal Business Name): MARATHON HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2013
Last Update Date: 04/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 HIGHWAY 30 E C/O BALDWIN FILTERS HEALTH CENTER
KEARNEY NE
68847-9797
US

IV. Provider business mailing address

20 WINOOSKI FALLS WAY SUITE 400
WINOOSKI VT
05404-2228
US

V. Phone/Fax

Practice location:
  • Phone: 308-237-8777
  • Fax:
Mailing address:
  • Phone: 802-857-0400
  • Fax: 802-857-0498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

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