Provider Demographics
NPI:1003838442
Name:MARCELIN MEDICAL CENTER
Entity Type:Organization
Organization Name:MARCELIN MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSCIAN/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:FITZGERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCELIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD,FAAP,FACGS
Authorized Official - Phone:434-336-9811
Mailing Address - Street 1:137 BAKER SREET
Mailing Address - Street 2:PO BOX 958
Mailing Address - City:EMPORIA
Mailing Address - State:VA
Mailing Address - Zip Code:23847
Mailing Address - Country:US
Mailing Address - Phone:434-336-9811
Mailing Address - Fax:434-336-0082
Practice Address - Street 1:137 BAKER SREET
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:VA
Practice Address - Zip Code:23847
Practice Address - Country:US
Practice Address - Phone:434-336-9811
Practice Address - Fax:434-336-0082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101231381261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005861128Medicaid
NC89065FCMedicaid
VA110008124Medicare PIN
VA005861128Medicaid