Provider Demographics
NPI:1124989520
Name:MARATHON HEALTH LLC
Entity type:Organization
Organization Name:MARATHON HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN EVERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-406-9645
Mailing Address - Street 1:1804 S GREEN ST
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-6504
Mailing Address - Country:US
Mailing Address - Phone:812-371-5762
Mailing Address - Fax:
Practice Address - Street 1:1804 S GREEN ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-6504
Practice Address - Country:US
Practice Address - Phone:812-371-5762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARATHON HEALTH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-11-24
Last Update Date:2025-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty