Provider Demographics
NPI:1962823310
Name:MARION MINOR MEDICAL LLC
Entity Type:Organization
Organization Name:MARION MINOR MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:
Authorized Official - First Name:MICHEAL
Authorized Official - Middle Name:D
Authorized Official - Last Name:CHARLTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-559-2314
Mailing Address - Street 1:136 BLOCK ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:AR
Mailing Address - Zip Code:72364-1956
Mailing Address - Country:US
Mailing Address - Phone:870-559-2314
Mailing Address - Fax:870-559-2392
Practice Address - Street 1:136 BLOCK ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:AR
Practice Address - Zip Code:72364-1956
Practice Address - Country:US
Practice Address - Phone:870-559-2314
Practice Address - Fax:870-559-2392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-01
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty