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General NPI Number Information
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NPI Number | 1124473400
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Entity Type | Organization
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Legal Business Name | MARILYN W. HORACEK, D.O.
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Dates
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Enumeration Date | 04/25/2016
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Last Update Date | 04/25/2016
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Provider Practice Location Address
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Address Line | 2115 CHAPLINE ST SUITE 208
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City | WHEELING
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State | WV
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Zip | 26003-3859
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Country | US
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Telephone | 304-217-3130
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Fax | 304-217-3134
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Provider Business Mailing Address
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Address Line | 2115 CHAPLINE ST SUITE 208
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City | WHEELING
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State | WV
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Zip | 26003-3859
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Country | US
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Telephone | 304-217-3130
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Fax | 304-217-3134
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Authorized Official
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Title or Position | OWNER
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Name | MARILYN W. HORACEK
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Credential | D.O.
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Telephone | 304-217-3130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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