Provider Demographics
NPI:1831515907
Name:MARBLE HILL MEDICAL CLINIC, LLC
Entity type:Organization
Organization Name:MARBLE HILL MEDICAL CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:573-986-8705
Mailing Address - Street 1:307 BROADWAY ST.
Mailing Address - Street 2:
Mailing Address - City:MARBLE HILL
Mailing Address - State:MO
Mailing Address - Zip Code:63764-8321
Mailing Address - Country:US
Mailing Address - Phone:573-238-0038
Mailing Address - Fax:573-238-0042
Practice Address - Street 1:307 BROADWAY ST.
Practice Address - Street 2:
Practice Address - City:MARBLE HILL
Practice Address - State:MO
Practice Address - Zip Code:63764-8321
Practice Address - Country:US
Practice Address - Phone:573-238-0038
Practice Address - Fax:573-238-0042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health