Healthcare Provider Details

I. General information

NPI: 1730712712
Provider Name (Legal Business Name): MARATHON HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2020
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7575 NORTHCLIFF AVE STE 403
BROOKLYN OH
44144-3266
US

IV. Provider business mailing address

PO BOX 5
WINOOSKI VT
05404-0005
US

V. Phone/Fax

Practice location:
  • Phone: 216-539-2702
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
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