MKSC Inc.

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

19164 Issued in WV

Legal business name

MKSC INC.

Doing business as

Marra Knee and Shoulder Center
Marra Knee and Shoulder Center, Inc.
Marra Knee, Hip, and Shoulder Center, Inc.

Practice address

300 Wharton Cir Ste 130
Triadelphia, WV 26059-1539

Phone

(304) 242-8042

Fax

(304) 242-8962

NPI assigned

Sep 18, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Dante A Marra, M.D.NPI 1295807725

Title

President

Phone

(304) 242-8042

Specialties & licenses 2

Addresses

Other names 3

• Marra Knee and Shoulder Center Doing business as
• Marra Knee and Shoulder Center, Inc. Doing business as
• Marra Knee, Hip, and Shoulder Center, Inc. Doing business as

Medicare fee-for-service enrollment

Enrolled in WV, OH, PA4 enrollments

Enrollment records 4

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Dante Anthony Marra, MD

  • Orthopaedic Surgery Physician
  • Triadelphia, WV
  • NPI 1295807725

  OH, PA

  Medicare reassignment Care Compare group NPD Authorized official
• Roberta Pamela Coulling, PA-C

  • Physician Assistant
  • Wheeling, WV
  • NPI 1437540044

  OH

  Medicare reassignment Care Compare group

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1410998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712275200000",
    "number": "1003218397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 WHARTON CIR STE 130",
            "city": "TRIADELPHIA",
            "state": "WV",
            "postal_code": "260591539",
            "telephone_number": "304-242-8042",
            "fax_number": "304-242-8962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 WHARTON CIR STE 130",
            "city": "TRIADELPHIA",
            "state": "WV",
            "postal_code": "260591539",
            "telephone_number": "304-242-8042",
            "fax_number": "304-242-8962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MKSC INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-18",
        "last_updated": "2024-04-05",
        "certification_date": "2024-04-05",
        "status": "A",
        "authorized_official_last_name": "MARRA",
        "authorized_official_first_name": "DANTE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "304-242-8042",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "WV",
            "license": "19164",
            "primary": true
        },
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Marra Knee and Shoulder Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Marra Knee and Shoulder Center, Inc.",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Marra Knee, Hip, and Shoulder Center, Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tammy Lynn Lowe
• Dante Anthony Marra, MD
• Roger L Menard
• Lisa Miehle, PHARMD
• Mackenzie Lee Mincey, M.D.
• Roger Nicholson
• Lauren Ostapowicz, BA
• Lisa Marie Park, FNP-BC
• Benjamin Arthur Paserba
• Amanda Weishar Patterson, PA-C

• Orthopaedic Surgery Physician in Triadelphia, WV
• Providers in Triadelphia, WV by specialty
• Orthopaedic Surgery Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.