Provider Demographics
NPI:1629212956
Name:MARLEY CREEK RURAL HEALTH INC
Entity Type:Organization
Organization Name:MARLEY CREEK RURAL HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:760-446-4571
Mailing Address - Street 1:900 N HERITAGE DR STE A
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-5540
Mailing Address - Country:US
Mailing Address - Phone:760-446-4571
Mailing Address - Fax:760-446-3819
Practice Address - Street 1:900 N HERITAGE DR STE A
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-5540
Practice Address - Country:US
Practice Address - Phone:760-446-4571
Practice Address - Fax:760-446-3819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-30
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty