NPIMap

Organization Active NPI

Marathon Health, LLC

  • General Practice Physician
  • West Melbourne, FL
National Provider Identifier
1598205221
Registry record updated Feb 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
MARATHON HEALTH, LLC
Practice address
2550 Wingate Boulevard
C/O Brevard Wellcare- South
West Melbourne, FL 32904
Phone
(802) 857-0400
NPI assigned
Feb 28, 2017
Organization subpart
Yes
Parent organization
MARATHON HEALTH, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 28, 2017

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 PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

2550 Wingate Boulevard
C/O Brevard Wellcare- South
West Melbourne, FL 32904

Mailing address

20 Winooski Falls Way Ste 400
Winooski, VT 05404-2239
Phone (802) 857-0434

Other names 1

  • Marathon Health at Brevard South Other name

National Provider Directory

National Provider Directory
Tax ID family
Marathon Health LLC130 organizations share this tax ID, including this one
Part of
Marathon Health LLC

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

2550 Wingate Blvd
West Melbourne, FL 32904
Phone (321) 369-9514

NPI Registry JSON

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

{
    "created_epoch": "1488240000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488240000000",
    "number": "1598205221",
    "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": "802-857-0434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2550 WINGATE BOULEVARD",
            "address_2": "C/O BREVARD WELLCARE- SOUTH",
            "city": "WEST MELBOURNE",
            "state": "FL",
            "postal_code": "32904",
            "telephone_number": "802-857-0400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARATHON HEALTH, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MARATHON HEALTH, LLC",
        "enumeration_date": "2017-02-28",
        "last_updated": "2017-02-28",
        "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": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Marathon Health at Brevard South",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in West Melbourne, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2017; 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.