Provider Demographics
NPI:1134114077
Name:MARION GENERAL HOSPITAL FOUNDATION, INC.
Entity Type:Organization
Organization Name:MARION GENERAL HOSPITAL FOUNDATION, INC.
Other - Org Name:MARION GENERAL HOSPITAL FOUNDATION, INC./MARION GENERAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:FEYH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-383-8700
Mailing Address - Street 1:4750 HEMPSTEAD STATION DR
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-5164
Mailing Address - Country:US
Mailing Address - Phone:800-875-0136
Mailing Address - Fax:937-619-4231
Practice Address - Street 1:1000 MCKINLEY PARK DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6399
Practice Address - Country:US
Practice Address - Phone:740-383-8700
Practice Address - Fax:740-383-8517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH991342207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2300254Medicaid
OH000000225591OtherBC/BS GRP PROVIDER NUMBER
OH2300254Medicaid
OH=========-00OtherGROUP BWC PROVIDER NUMBER
OH2300254Medicaid
MA9321081Medicare PIN