MEDICARE: MARATHON HEALTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1235634700
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARATHON HEALTH LLC

Provider Business Mailing Address
First Line	:	20 WINOOSKI FALLS WAY STE 400
Second Line	:
City	:	WINOOSKI
State	:	VT
Zip	:	05404-2239
Country	:	US
Telephone Number	:	802-857-0434
Fax Number	:

Provider Business Practice Location Address
First Line	:	237 PAYNE PKWY UNIT 101
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34237-7018
Country	:	US
Telephone Number	:	802-857-0400
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JERRY FORD
Credential	:
Telephone Number	:	802-857-0400

Provider Enumeration Date	:	03/27/2018
Last Update Date	:	03/27/2018

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Directions to “MARATHON HEALTH LLC ” Practice Location

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