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General NPI Number Information
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NPI Number | 1578054649
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Entity Type | Organization
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Legal Business Name | MARC'S LEATHER REPAIR, LLC
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Dates
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Enumeration Date | 05/24/2018
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Last Update Date | 05/24/2018
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Provider Practice Location Address
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Address Line | 104 E 4TH ST
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City | MARION
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State | IN
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Zip | 46952-4000
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Country | US
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Telephone | 765-664-5475
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Fax |
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Provider Business Mailing Address
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Address Line | 104 E 4TH ST
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City | MARION
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State | IN
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Zip | 46952-4000
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Country | US
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Telephone | 765-664-5475
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | MR. MARC A LOBDELL
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Credential | LPN, PST
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Telephone | 765-661-0369
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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