Provider Demographics
NPI:1093039331
Name:MARATHON HEALTH, INC.
Entity Type:Organization
Organization Name:MARATHON HEALTH, INC.
Other - Org Name:MARATHON HEALTH AT PLANTATION
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-857-0400
Mailing Address - Street 1:354 MOUNTAIN VIEW DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-5968
Mailing Address - Country:US
Mailing Address - Phone:802-857-0400
Mailing Address - Fax:802-655-3607
Practice Address - Street 1:401 NW 70TH TER
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2239
Practice Address - Country:US
Practice Address - Phone:954-513-3530
Practice Address - Fax:954-513-3539
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARATHON HEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site