Provider Demographics
| NPI: | 1912965732 |
|---|---|
| Name: | MARIETTA HEALTH CARE PHYSICIANS, INC. |
| Entity type: | Organization |
| Organization Name: | MARIETTA HEALTH CARE PHYSICIANS, INC. |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | VP, FINANCE & CFO |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | SCOTT |
| Authorized Official - Middle Name: | GERARD |
| Authorized Official - Last Name: | SILVESTRI |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 740-374-1641 |
| Mailing Address - Street 1: | PO BOX 449 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | MARIETTA |
| Mailing Address - State: | OH |
| Mailing Address - Zip Code: | 45750-0449 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 740-374-4500 |
| Mailing Address - Fax: | 740-374-5887 |
| Practice Address - Street 1: | 416 COLEGATE DR BLDG 3 |
| Practice Address - Street 2: | |
| Practice Address - City: | MARIETTA |
| Practice Address - State: | OH |
| Practice Address - Zip Code: | 45750-9549 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 740-374-4500 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-05-02 |
| Last Update Date: | 2021-02-18 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| OH | 207Q00000X, 207RE0101X, 207YX0007X, 208000000X, 363LF0000X, 208100000X, 208200000X, 2084P0800X, 208800000X, 208M00000X, 207R00000X | |
| 207L00000X, 207RH0003X, 207V00000X, 208600000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Multi-Specialty | |
| No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
| No | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Multi-Specialty |
| No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
| No | 207YX0007X | Allopathic & Osteopathic Physicians | Otolaryngology | Plastic Surgery within the Head & Neck | Group - Multi-Specialty |
| No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |
| No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
| No | 208200000X | Allopathic & Osteopathic Physicians | Plastic Surgery | Group - Multi-Specialty | |
| No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
| No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
| No | 208800000X | Allopathic & Osteopathic Physicians | Urology | Group - Multi-Specialty | |
| No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| OH | 0974727 | Medicaid | |
| WV | 0008925000 | Medicaid | |
| 9266201 | Medicare PIN | ||
| WV | 0008925000 | Medicaid |