Provider Demographics
NPI:1003218397
Name:MKSC INC.
Entity Type:Organization
Organization Name:MKSC INC.
Other - Org Name:MARRA KNEE, HIP, AND SHOULDER CENTER, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANTE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-242-8042
Mailing Address - Street 1:300 WHARTON CIR STE 130
Mailing Address - Street 2:
Mailing Address - City:TRIADELPHIA
Mailing Address - State:WV
Mailing Address - Zip Code:26059-1539
Mailing Address - Country:US
Mailing Address - Phone:304-242-8042
Mailing Address - Fax:304-242-8962
Practice Address - Street 1:300 WHARTON CIR STE 130
Practice Address - Street 2:
Practice Address - City:TRIADELPHIA
Practice Address - State:WV
Practice Address - Zip Code:26059-1539
Practice Address - Country:US
Practice Address - Phone:304-242-8042
Practice Address - Fax:304-242-8962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-18
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19164207X00000X
332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No332900000XSuppliersNon-Pharmacy Dispensing Site