Provider Demographics
NPI:1932450194
Name:MARATHON SPORTS AND OTHOPEDICS
Entity type:Organization
Organization Name:MARATHON SPORTS AND OTHOPEDICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HARMON
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:707-495-2464
Mailing Address - Street 1:PO BOX 110076
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99511-0076
Mailing Address - Country:US
Mailing Address - Phone:707-495-2464
Mailing Address - Fax:303-646-0358
Practice Address - Street 1:12600 LUPINE RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99516-3223
Practice Address - Country:US
Practice Address - Phone:707-495-2464
Practice Address - Fax:303-646-0358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-28
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK10007053332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies