Provider Demographics
NPI:1417259680
Name:MARION INDEPENDENT PHYSICIANS ASSOCIATION, LLC
Entity Type:Organization
Organization Name:MARION INDEPENDENT PHYSICIANS ASSOCIATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HEMPSTEAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-387-7200
Mailing Address - Street 1:1167 INDEPENDENCE AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-6360
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1069 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-1400
Practice Address - Country:US
Practice Address - Phone:740-387-4578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-22
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2104127Medicaid