Provider Demographics
NPI:1093376840
Name:MARATHON HEALTH, LLC
Entity Type:Organization
Organization Name:MARATHON HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-857-0400
Mailing Address - Street 1:PO BOX 5
Mailing Address - Street 2:
Mailing Address - City:WINOOSKI
Mailing Address - State:VT
Mailing Address - Zip Code:05404-0005
Mailing Address - Country:US
Mailing Address - Phone:802-857-0400
Mailing Address - Fax:
Practice Address - Street 1:807 CHEROKEE DR STE 5
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MO
Practice Address - Zip Code:65340-1690
Practice Address - Country:US
Practice Address - Phone:660-202-4227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARATHON HEALTH, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty