Provider Demographics
NPI:1336916139
Name:THE MARYSVILLE UNION
Entity Type:Organization
Organization Name:THE MARYSVILLE UNION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BORLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:740-405-2674
Mailing Address - Street 1:16645 SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-3510
Mailing Address - Country:US
Mailing Address - Phone:937-250-1433
Mailing Address - Fax:
Practice Address - Street 1:16645 SQUARE DR
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-3510
Practice Address - Country:US
Practice Address - Phone:937-250-1433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE MARYSVILLE UNION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health