Provider Demographics
NPI:1437330388
Name:MARION AREA NEUROLOGICAL CONSULTING
Entity Type:Organization
Organization Name:MARION AREA NEUROLOGICAL CONSULTING
Other - Org Name:MARION AREA NEUROLOGICAL CONSULTING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:M.D. OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:B
Authorized Official - Last Name:KELLUM
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:740-725-8300
Mailing Address - Street 1:1728 MARION WALDO RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-7457
Mailing Address - Country:US
Mailing Address - Phone:740-725-8300
Mailing Address - Fax:740-725-1213
Practice Address - Street 1:1728 MARION WALDO RD
Practice Address - Street 2:SUITE B
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-7457
Practice Address - Country:US
Practice Address - Phone:740-725-8300
Practice Address - Fax:740-725-1213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35051174K174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0599580Medicaid
OH0599580Medicaid
OHA16082Medicare UPIN
OH9307441Medicare PIN