Provider Demographics
NPI:1245217314
Name:MARMEDICA LLC
Entity Type:Organization
Organization Name:MARMEDICA LLC
Other - Org Name:FLORALA FAMILY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:MARSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-858-3241
Mailing Address - Street 1:24015 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLORALA
Mailing Address - State:AL
Mailing Address - Zip Code:36442-3519
Mailing Address - Country:US
Mailing Address - Phone:334-858-3241
Mailing Address - Fax:334-858-3318
Practice Address - Street 1:24015 5TH AVE
Practice Address - Street 2:
Practice Address - City:FLORALA
Practice Address - State:AL
Practice Address - Zip Code:36442-3519
Practice Address - Country:US
Practice Address - Phone:334-858-3241
Practice Address - Fax:334-858-3318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALK204Medicare ID - Type Unspecified