Provider Demographics
NPI:1962470401
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:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HEMPSTEAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-387-7200
Mailing Address - Street 1:125 EXECUTIVE DR
Mailing Address - Street 2:SUITE 207
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-6285
Mailing Address - Country:US
Mailing Address - Phone:740-223-8056
Mailing Address - Fax:740-223-7095
Practice Address - Street 1:125 EXECUTIVE DR
Practice Address - Street 2:SUITE 207
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6285
Practice Address - Country:US
Practice Address - Phone:740-223-8056
Practice Address - Fax:740-223-7095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-10
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAD369131Medicare ID - Type Unspecified