Provider Demographics
NPI:1073645826
Name:MARION SURGICAL ASSOCIATES, INC
Entity Type:Organization
Organization Name:MARION SURGICAL ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCLELLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-363-5799
Mailing Address - Street 1:1708 LOCUST AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-1332
Mailing Address - Country:US
Mailing Address - Phone:304-366-0346
Mailing Address - Fax:
Practice Address - Street 1:1708 LOCUST AVE STE 102
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-1332
Practice Address - Country:US
Practice Address - Phone:304-366-0346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Not Answered2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0008918000Medicaid
WV0008918000Medicaid