Provider Demographics
NPI:1790931418
Name:MARCO MEDICAL GROUP INC
Entity Type:Organization
Organization Name:MARCO MEDICAL GROUP INC
Other - Org Name:MARCO MEDICAL GROUP INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:GUIDRY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:239-394-4111
Mailing Address - Street 1:19 BALD EAGLE DR STE B
Mailing Address - Street 2:
Mailing Address - City:MARCO ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:34145-3580
Mailing Address - Country:US
Mailing Address - Phone:239-394-4111
Mailing Address - Fax:
Practice Address - Street 1:19 BALD EAGLE DR STE B
Practice Address - Street 2:
Practice Address - City:MARCO ISLAND
Practice Address - State:FL
Practice Address - Zip Code:34145-3580
Practice Address - Country:US
Practice Address - Phone:239-394-4111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-13
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty