Provider Demographics
NPI:1124473400
Name:MARILYN W. HORACEK, D.O.
Entity type:Organization
Organization Name:MARILYN W. HORACEK, D.O.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:W
Authorized Official - Last Name:HORACEK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:304-217-3130
Mailing Address - Street 1:2115 CHAPLINE ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-3859
Mailing Address - Country:US
Mailing Address - Phone:304-217-3130
Mailing Address - Fax:304-217-3134
Practice Address - Street 1:2115 CHAPLINE ST
Practice Address - Street 2:SUITE 208
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-3859
Practice Address - Country:US
Practice Address - Phone:304-217-3130
Practice Address - Fax:304-217-3134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-25
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty