{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "MARIETTA MEMORIAL HOSPITAL",
"LastName": null,
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"NamePrefix": null,
"NameSuffix": null,
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"FirstLineMailingAddress": "401 MATTHEW ST",
"SecondLineMailingAddress": "ATTN: PHARMACY",
"MailingAddressCityName": "MARIETTA",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "45750-1635",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "740-374-1446",
"MailingAddressFaxNumber": "740-568-5484",
"FirstLinePracticeLocationAddress": "807 FARSON ST STE 130",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BELPRE",
"PracticeLocationAddressStateName": "OH",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "740-374-1583",
"PracticeLocationAddressFaxNumber": "740-374-1604",
"EnumerationDate": "05/28/2008",
"LastUpdateDate": "01/29/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MCGEE",
"AuthorizedOfficialFirstName": "VICTORIA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PROVIDER ENROLLMENT SUPERVISOR",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "740-374-6090",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}