Provider Demographics
NPI:1497836340
Name:MARION PEDIATRICS LLC
Entity Type:Organization
Organization Name:MARION PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAGGARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-668-5989
Mailing Address - Street 1:1411 W BELLA DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46953-5250
Mailing Address - Country:US
Mailing Address - Phone:765-668-5989
Mailing Address - Fax:765-651-6642
Practice Address - Street 1:1411 W BELLA DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46953-5250
Practice Address - Country:US
Practice Address - Phone:765-668-5989
Practice Address - Fax:765-651-6642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200458820Medicaid
IN200458820Medicaid