Provider Demographics
NPI:1598180226
Name:MARATHON HEALTH, INC.
Entity Type:Organization
Organization Name:MARATHON HEALTH, INC.
Other - Org Name:MARATHON HEALTH AT CARNIVAL
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-857-0400
Mailing Address - Street 1:20 WINOOSKI FALLS WAY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:WINOOSKI
Mailing Address - State:VT
Mailing Address - Zip Code:05404-2228
Mailing Address - Country:US
Mailing Address - Phone:802-857-0400
Mailing Address - Fax:
Practice Address - Street 1:3655 NW 87TH AVE
Practice Address - Street 2:C/O CARNIVAL HEALTH CENTER
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-2418
Practice Address - Country:US
Practice Address - Phone:305-406-8375
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARATHON HEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-05
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No332900000XSuppliersNon-Pharmacy Dispensing SiteGroup - Single Specialty