Provider Demographics
NPI:1972226496
Name:MARATHON HEALTH LLC
Entity Type:Organization
Organization Name:MARATHON HEALTH LLC
Other - Org Name:CITY'S HEALTH AND WELLNESS CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-857-0400
Mailing Address - Street 1:20 WINOOSKI FALLS WAY STE 400
Mailing Address - Street 2:
Mailing Address - City:WINOOSKI
Mailing Address - State:VT
Mailing Address - Zip Code:05404-2239
Mailing Address - Country:US
Mailing Address - Phone:802-857-0400
Mailing Address - Fax:
Practice Address - Street 1:6701 N HIATUS RD
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-6406
Practice Address - Country:US
Practice Address - Phone:754-263-0350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARATHON HEALTH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty