Provider Demographics
NPI:1053403956
Name:MARCON GROUP, INC.
Entity type:Organization
Organization Name:MARCON GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCHAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-259-0530
Mailing Address - Street 1:3095 KERNER BLVD
Mailing Address - Street 2:SUITE R
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-5421
Mailing Address - Country:US
Mailing Address - Phone:415-259-0530
Mailing Address - Fax:415-259-0540
Practice Address - Street 1:3095 KERNER BLVD
Practice Address - Street 2:SUITE R
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-5421
Practice Address - Country:US
Practice Address - Phone:415-259-0530
Practice Address - Fax:415-259-0540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49990332B00000X
CA103111332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME02272FMedicaid
CA1119790001Medicare ID - Type UnspecifiedMEDICARE PROVIDER #