Basic Information
| Provider Information | |||||||||
| NPI: | 1518413657 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARION INTEGRATED HEALTH CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7967 CINCINNATI DAYTON RD | ||||||||
| Address2: | SUITE P | ||||||||
| City: | WEST CHESTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450692026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5136850949 | ||||||||
| FaxNumber: | 5132820946 | ||||||||
| Practice Location | |||||||||
| Address1: | 491 E CENTER ST | ||||||||
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| City: | MARION | ||||||||
| State: | OH | ||||||||
| PostalCode: | 433024244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403866580 | ||||||||
| FaxNumber: | 7403866586 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2016 | ||||||||
| LastUpdateDate: | 08/10/2021 | ||||||||
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| AuthorizedOfficialLastName: | THARP | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | ANDREW | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8178071288 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DC | ||||||||
| NPICertificationDate: | 08/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 208D00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.