Provider Demographics
NPI:1770616963
Name:MARION WOMEN'S HEALTH CENTER INC
Entity type:Organization
Organization Name:MARION WOMEN'S HEALTH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAYBALAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:MOODLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-383-2776
Mailing Address - Street 1:960 S PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-6225
Mailing Address - Country:US
Mailing Address - Phone:740-383-2776
Mailing Address - Fax:740-383-2978
Practice Address - Street 1:960 S PROSPECT ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6225
Practice Address - Country:US
Practice Address - Phone:740-383-2776
Practice Address - Fax:740-383-2978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0210069Medicaid
OH2255198Medicaid
OH0776563Medicare ID - Type Unspecified
OHNP00432Medicare ID - Type Unspecified
OHF96620Medicare UPIN
OH0210069Medicaid