Provider Demographics
NPI:1275006744
Name:MARION DIAGNOSTIC CENTER LLC
Entity Type:Organization
Organization Name:MARION DIAGNOSTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURAE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHARI
Authorized Official - Middle Name:D
Authorized Official - Last Name:GAMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN
Authorized Official - Phone:618-993-1400
Mailing Address - Street 1:3003 CIVIC CIRCLE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-5259
Mailing Address - Country:US
Mailing Address - Phone:618-993-1400
Mailing Address - Fax:618-993-1522
Practice Address - Street 1:3003 CIVIC CIRCLE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-5259
Practice Address - Country:US
Practice Address - Phone:618-993-1400
Practice Address - Fax:618-993-1522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty