Provider Demographics
NPI:1598941858
Name:MARION MEDICAL SUPPLY, LLC
Entity Type:Organization
Organization Name:MARION MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CORNELIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-220-8308
Mailing Address - Street 1:PO BOX 502
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MS
Mailing Address - Zip Code:39429-0502
Mailing Address - Country:US
Mailing Address - Phone:504-220-8308
Mailing Address - Fax:985-651-4440
Practice Address - Street 1:505 S. HIGH SCHOOL AVE
Practice Address - Street 2:SUITE A
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70069
Practice Address - Country:US
Practice Address - Phone:504-220-8308
Practice Address - Fax:985-651-4440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies