Provider Demographics
NPI:1457699076
Name:MARVMED LLC
Entity Type:Organization
Organization Name:MARVMED LLC
Other - Org Name:FLAGLER & VOLUSIA REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLISI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-237-4003
Mailing Address - Street 1:1400 E MOODY BLVD
Mailing Address - Street 2:
Mailing Address - City:BUNNELL
Mailing Address - State:FL
Mailing Address - Zip Code:32110-5916
Mailing Address - Country:US
Mailing Address - Phone:386-237-4003
Mailing Address - Fax:
Practice Address - Street 1:1400 E MOODY BLVD
Practice Address - Street 2:
Practice Address - City:BUNNELL
Practice Address - State:FL
Practice Address - Zip Code:32110-5916
Practice Address - Country:US
Practice Address - Phone:386-237-4003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty