Provider Demographics
NPI: | 1710925045 |
---|---|
Name: | MARION INDEPENDENT PHYSICIANS ASSOCIATION, LLC |
Entity Type: | Organization |
Organization Name: | MARION INDEPENDENT PHYSICIANS ASSOCIATION, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | MD |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SRINIVAS |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | RAVI |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 740-387-7793 |
Mailing Address - Street 1: | P.O. BOX 887 |
Mailing Address - Street 2: | |
Mailing Address - City: | MARION |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 43301-0887 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 740-223-3496 |
Mailing Address - Fax: | 740-383-6463 |
Practice Address - Street 1: | 30D EXECUTIVE DRIVE |
Practice Address - Street 2: | |
Practice Address - City: | MARION |
Practice Address - State: | OH |
Practice Address - Zip Code: | 43302-6310 |
Practice Address - Country: | US |
Practice Address - Phone: | 740-387-7793 |
Practice Address - Fax: | 740-387-7795 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | MARION INDEPENDENT PHYSICIANS ASSOCIATION, LLC |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2006-06-02 |
Last Update Date: | 2021-06-28 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 133V00000X | Dietary & Nutritional Service Providers | Dietitian, Registered | Group - Multi-Specialty | |
No | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Multi-Specialty | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
No | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Multi-Specialty |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 208800000X | Allopathic & Osteopathic Physicians | Urology | Group - Multi-Specialty | |
No | 213E00000X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Group - Multi-Specialty | |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OH | 2105251 | Medicaid | |
OH | 2105242 | Medicaid | |
OH | 2105288 | Medicaid | |
OH | 2105359 | Medicaid | |
OH | 2105519 | Medicaid | |
OH | 2105386 | Medicaid | |
OH | 2105224 | Medicaid | |
OH | 2105322 | Medicaid | |
OH | 2105331 | Medicaid | |
OH | 2104136 | Medicaid | |
OH | 2105411 | Medicaid | |
OH | 2105475 | Medicaid | |
OH | 2104127 | Medicaid | |
OH | 2105279 | Medicaid | |
9296861 | Medicare ID - Type Unspecified | ||
OH | 2105251 | Medicaid | |
1291220001 | Medicare NSC | ||
9296878 | Medicare ID - Type Unspecified | ||
OH | 2105519 | Medicaid | |
OH | 2105288 | Medicaid | |
OH | 2105242 | Medicaid | |
9296864 | Medicare ID - Type Unspecified | ||
9296883 | Medicare ID - Type Unspecified | ||
9296879 | Medicare ID - Type Unspecified | ||
9296888 | Medicare ID - Type Unspecified | ||
OH | 2105411 | Medicaid | |
9296875 | Medicare ID - Type Unspecified | ||
9296865 | Medicare ID - Type Unspecified | ||
OH | 2105386 | Medicaid | |
OH | 2105224 | Medicaid | |
OH | 2104136 | Medicaid |