NPIMap

Organization Active NPI

Marathon Health, Inc.

  • General Practice Physician
  • Melbourne, FL
National Provider Identifier
1356883771
Registry record updated Nov 16, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
MARATHON HEALTH, INC.
Practice address
2694 Judge Fran Jamieson Way
C/O Brevard Wellcare- Central
Melbourne, FL 32940
Phone
(321) 252-1169
Fax
(321) 989-0316
NPI assigned
Nov 16, 2016
Last updated
Nov 16, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
MARATHON HEALTH, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 16, 2016

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

Authorized official

Name
Jerry Ford
Title
Ceo
Phone
(802) 857-0400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X NU Primary

Addresses

Primary practice location

2694 Judge Fran Jamieson Way
C/O Brevard Wellcare- Central
Melbourne, FL 32940

Mailing address

20 Winooski Falls Way Ste 400
Winooski, VT 05404-2239
Phone (802) 857-0400

Other names 1

  • Marathon Health at Brevard Central Other name

National Provider Directory

National Provider Directory
Tax ID family
Marathon Health Inc166 organizations share this tax ID, including this one
Part of
Marathon Health Inc

Organizations with this tax ID in the same state 19

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 19

Locations

2694 Judge Fran Jamieson Way
Melbourne, FL 32940
Phone (321) 252-1169

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1479254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479254400000",
    "number": "1356883771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 WINOOSKI FALLS WAY STE 400",
            "city": "WINOOSKI",
            "state": "VT",
            "postal_code": "054042239",
            "telephone_number": "802-857-0400",
            "fax_number": "802-419-4876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2694 JUDGE FRAN JAMIESON WAY",
            "address_2": "C/O BREVARD WELLCARE- CENTRAL",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "32940",
            "telephone_number": "321-252-1169",
            "fax_number": "321-989-0316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARATHON HEALTH, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MARATHON HEALTH, INC.",
        "enumeration_date": "2016-11-16",
        "last_updated": "2016-11-16",
        "status": "A",
        "authorized_official_last_name": "FORD",
        "authorized_official_first_name": "JERRY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "802-857-0400"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Marathon Health at Brevard Central",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Melbourne, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.