Provider Demographics
NPI:1790444974
Name:MARATHON HEALTH, LLC
Entity Type:Organization
Organization Name:MARATHON HEALTH, LLC
Other - Org Name:UWC- CRESTWOOD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-304-1933
Mailing Address - Street 1:4736 CAL SAG RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CRESTWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60445
Mailing Address - Country:US
Mailing Address - Phone:312-421-1016
Mailing Address - Fax:708-390-7001
Practice Address - Street 1:4736 CAL SAG RD
Practice Address - Street 2:SUITE A
Practice Address - City:CRESTWOOD
Practice Address - State:IL
Practice Address - Zip Code:60445
Practice Address - Country:US
Practice Address - Phone:312-421-1016
Practice Address - Fax:708-390-7001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-15
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center