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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1760157762
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARATHON HEALTH LLC

Provider Business Mailing Address
First Line	:	20 WINOOSKI FALLS WAY
Second Line	:
City	:	WINOOSKI
State	:	VT
Zip	:	05404-2228
Country	:	US
Telephone Number	:	802-857-0400
Fax Number	:

Provider Business Practice Location Address
First Line	:	3300 FOREST HILL BLVD BLDG E
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406-5813
Country	:	US
Telephone Number	:	561-437-6584
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JEFF WELLS
Credential	:	MD
Telephone Number	:	802-857-0400

Provider Enumeration Date	:	08/11/2021
Last Update Date	:	08/11/2021

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