Provider Demographics
NPI:1124173935
Name:COUNTY OF MARION BOARD OF HEALTH
Entity type:Organization
Organization Name:COUNTY OF MARION BOARD OF HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:304-366-3360
Mailing Address - Street 1:300 2ND ST
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-2830
Mailing Address - Country:US
Mailing Address - Phone:304-366-3360
Mailing Address - Fax:304-363-8217
Practice Address - Street 1:300 2ND ST
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-2830
Practice Address - Country:US
Practice Address - Phone:304-366-3360
Practice Address - Fax:304-363-8217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVMAFV93941Medicare ID - Type UnspecifiedROSTER FLU BILLING
WVMA9346761Medicare ID - Type Unspecified