Provider Demographics
NPI:1922291962
Name:THE CHILDREN'S CLINIC OF MARION
Entity Type:Organization
Organization Name:THE CHILDREN'S CLINIC OF MARION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LACEY
Authorized Official - Middle Name:HOLLIFIELD
Authorized Official - Last Name:MCKINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-659-2000
Mailing Address - Street 1:1225 W HENDERSON ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-4807
Mailing Address - Country:US
Mailing Address - Phone:828-659-2000
Mailing Address - Fax:828-659-2003
Practice Address - Street 1:1225 W HENDERSON ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-4807
Practice Address - Country:US
Practice Address - Phone:828-659-2000
Practice Address - Fax:828-659-2003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-00963208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty