Provider Demographics
NPI:1427011386
Name:MARATHON MEDICAL PC
Entity Type:Organization
Organization Name:MARATHON MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRINA
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHAPMAN-SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:260-925-0666
Mailing Address - Street 1:1306 E 7TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:AUBURN
Mailing Address - State:IN
Mailing Address - Zip Code:46706-2536
Mailing Address - Country:US
Mailing Address - Phone:260-925-0666
Mailing Address - Fax:920-925-0669
Practice Address - Street 1:1306 E 7TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:AUBURN
Practice Address - State:IN
Practice Address - Zip Code:46706-2536
Practice Address - Country:US
Practice Address - Phone:260-925-0666
Practice Address - Fax:920-925-0669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01038514207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200185690AMedicaid
IN000000104774OtherBC/BS GROUP NUMBER
IN000000104774OtherBC/BS GROUP NUMBER