Provider Demographics
NPI:1750463717
Name:MARIETTA HEALTH CARE SYSTEMS, INC.
Entity type:Organization
Organization Name:MARIETTA HEALTH CARE SYSTEMS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:D
Authorized Official - Last Name:DENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-373-1449
Mailing Address - Street 1:311 LL PUTNAM STREET
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-3021
Mailing Address - Country:US
Mailing Address - Phone:740-373-1449
Mailing Address - Fax:740-373-4063
Practice Address - Street 1:800 PIKE ST
Practice Address - Street 2:SUITE 2
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-3507
Practice Address - Country:US
Practice Address - Phone:740-373-1449
Practice Address - Fax:740-373-4063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9280589OtherOH MEDICARE LOCATION ID
OH9280585OtherOH MEDICARE LOCATION ID
OH9280587OtherOH MEDICARE LOCATION ID
OH9280586OtherOH MEDICARE LOCATION ID
OH9280581OtherOH MEDICARE LOCATION ID
OHLO230931Medicaid
WV0009922000Medicaid
WV6703032000Medicaid
OH9280582OtherOH MEDICARE LOCATION ID
OH9280588OtherOH MEDICARE LOCATION ID
OH=========-00OtherBWC
OH=========-00OtherBWC