Provider Demographics
NPI:1063171486
Name:MARATHON HEALTH, LLC
Entity type:Organization
Organization Name:MARATHON HEALTH, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-304-1933
Mailing Address - Street 1:28600 BELLA VISTA PKWY STE 2010A
Mailing Address - Street 2:
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-1604
Mailing Address - Country:US
Mailing Address - Phone:312-421-1016
Mailing Address - Fax:630-634-0402
Practice Address - Street 1:28600 BELLA VISTA PKWY STE 2010A
Practice Address - Street 2:
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555-1604
Practice Address - Country:US
Practice Address - Phone:312-421-1016
Practice Address - Fax:630-634-0402
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARATHON HEALTH, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-12-13
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center