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 |