Healthcare Provider Details

I. General information

NPI: 1750463717
Provider Name (Legal Business Name): MARIETTA HEALTH CARE SYSTEMS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 02/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 PIKE ST SUITE 2
MARIETTA OH
45750-3507
US

IV. Provider business mailing address

311 LL PUTNAM STREET
MARIETTA OH
45750-3021
US

V. Phone/Fax

Practice location:
  • Phone: 740-373-1449
  • Fax: 740-373-4063
Mailing address:
  • Phone: 740-373-1449
  • Fax: 740-373-4063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LLOYD D DENNIS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 740-373-1449