Provider Demographics
NPI:1285639989
Name:MARQUIS HEALTHCARE, INC.
Entity Type:Organization
Organization Name:MARQUIS HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:WORSTELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-491-0550
Mailing Address - Street 1:4051 WHIPPLE AVE NW
Mailing Address - Street 2:STE. A
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2977
Mailing Address - Country:US
Mailing Address - Phone:330-491-0550
Mailing Address - Fax:800-860-8832
Practice Address - Street 1:4051 WHIPPLE AVE NW
Practice Address - Street 2:STE. A
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2977
Practice Address - Country:US
Practice Address - Phone:330-491-0550
Practice Address - Fax:800-860-8832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-17
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2152736Medicaid
OH2152736Medicaid