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General NPI Number Information
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NPI Number | 1033773544
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Entity Type | Organization
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Legal Business Name | MARATHON HEALTH, LLC
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Dates
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Enumeration Date | 04/30/2019
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Last Update Date | 02/19/2021
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Provider Practice Location Address
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Address Line | 1865 S MAIN ST STE 12
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City | SALT LAKE CITY
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State | UT
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Zip | 84115-2090
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Country | US
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Telephone | 801-657-5580
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5
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City | WINOOSKI
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State | VT
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Zip | 05404-0005
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JERRY FORD
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Credential |
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Telephone | 802-857-0400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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