Healthcare Provider Details

I. General information

NPI: 1770616963
Provider Name (Legal Business Name): MARION WOMEN'S HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 05/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 S PROSPECT ST
MARION OH
43302-6225
US

IV. Provider business mailing address

960 S PROSPECT ST
MARION OH
43302-6225
US

V. Phone/Fax

Practice location:
  • Phone: 740-383-2776
  • Fax: 740-383-2978
Mailing address:
  • Phone: 740-383-2776
  • Fax: 740-383-2978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. JAYBALAN R MOODLEY
Title or Position: OWNER
Credential: MD
Phone: 740-383-2776