Healthcare Provider Details

I. General information

NPI: 1326657495
Provider Name (Legal Business Name): MARATHON MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2020
Last Update Date: 07/24/2020
Certification Date: 07/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

539 WINDSOR PARK DR
DAYTON OH
45459-4112
US

IV. Provider business mailing address

539 WINDSOR PARK DR
DAYTON OH
45459-4112
US

V. Phone/Fax

Practice location:
  • Phone: 937-589-2277
  • Fax: 937-502-3877
Mailing address:
  • Phone: 937-589-2277
  • Fax: 937-502-3877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY ONYIA
Title or Position: CEO
Credential:
Phone: 937-589-2277