MARION INDEPENDENT PHYSICIANS ASSOCIATION, LLC

Provider Demographics

• NPI: 1710925045
• Name: MARION INDEPENDENT PHYSICIANS ASSOCIATION, LLC
• Entity type: Organization
• Organization Name: MARION INDEPENDENT PHYSICIANS ASSOCIATION, LLC
• Authorized Official - Title/Position: MD
• Authorized Official - First Name: SRINIVAS
• Authorized Official - Last Name: RAVI
• Authorized Official - Phone: 740-387-7793
• Mailing Address - Street 1: P.O. BOX 887
• Mailing Address - City: MARION
• Mailing Address - State: OH
• Mailing Address - Zip Code: 43301-0887
• Mailing Address - Country: US
• Mailing Address - Phone: 740-223-3496
• Mailing Address - Fax: 740-383-6463
• Practice Address - Street 1: 30D EXECUTIVE DRIVE
• Practice Address - City: MARION
• Practice Address - State: OH
• Practice Address - Zip Code: 43302-6310
• Practice Address - Country: US
• Practice Address - Phone: 740-387-7793
• Practice Address - Fax: 740-387-7795
• EIN: <UNAVAIL>
• Is Organization Subpart?: Yes
• Parent Organization LBN: MARION INDEPENDENT PHYSICIANS ASSOCIATION, LLC
• Parent Organization TIN: <UNAVAIL>
• Enumeration Date: 2006-06-02
• Last Update Date: 2021-06-28

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	207Q00000X	Allopathic & Osteopathic Physicians	Family Medicine		Group - Multi-Specialty
No	133V00000X	Dietary & Nutritional Service Providers	Dietitian, Registered		Group - Multi-Specialty
No	207L00000X	Allopathic & Osteopathic Physicians	Anesthesiology		Group - Multi-Specialty
No	207R00000X	Allopathic & Osteopathic Physicians	Internal Medicine		Group - Multi-Specialty
No	207RC0000X	Allopathic & Osteopathic Physicians	Internal Medicine	Cardiovascular Disease	Group - Multi-Specialty
No	207RH0003X	Allopathic & Osteopathic Physicians	Internal Medicine	Hematology & Oncology	Group - Multi-Specialty
No	207X00000X	Allopathic & Osteopathic Physicians	Orthopaedic Surgery		Group - Multi-Specialty
No	2084N0400X	Allopathic & Osteopathic Physicians	Psychiatry & Neurology	Neurology	Group - Multi-Specialty
No	2084P0800X	Allopathic & Osteopathic Physicians	Psychiatry & Neurology	Psychiatry	Group - Multi-Specialty
No	208600000X	Allopathic & Osteopathic Physicians	Surgery		Group - Multi-Specialty
No	208800000X	Allopathic & Osteopathic Physicians	Urology		Group - Multi-Specialty
No	213E00000X	Podiatric Medicine & Surgery Service Providers	Podiatrist		Group - Multi-Specialty
No	225100000X	Respiratory, Developmental, Rehabilitative and Restorative Service Providers	Physical Therapist		Group - Multi-Specialty
No	363A00000X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant		Group - Multi-Specialty
No	363L00000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
OH	2105251	Medicaid
OH	2105242	Medicaid
OH	2105288	Medicaid
OH	2105359	Medicaid
OH	2105519	Medicaid
OH	2105386	Medicaid
OH	2105224	Medicaid
OH	2105322	Medicaid
OH	2105331	Medicaid
OH	2104136	Medicaid
OH	2105411	Medicaid
OH	2105475	Medicaid
OH	2104127	Medicaid
OH	2105279	Medicaid
	9296861	Medicare ID - Type Unspecified
OH	2105251	Medicaid
	1291220001	Medicare NSC
	9296878	Medicare ID - Type Unspecified
OH	2105519	Medicaid
OH	2105288	Medicaid
OH	2105242	Medicaid
	9296864	Medicare ID - Type Unspecified
	9296883	Medicare ID - Type Unspecified
	9296879	Medicare ID - Type Unspecified
	9296888	Medicare ID - Type Unspecified
OH	2105411	Medicaid
	9296875	Medicare ID - Type Unspecified
	9296865	Medicare ID - Type Unspecified
OH	2105386	Medicaid
OH	2105224	Medicaid
OH	2104136	Medicaid