Provider Demographics
NPI:1053623116
Name:MARION PHYSICIAN SERVICES LLC
Entity type:Organization
Organization Name:MARION PHYSICIAN SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:T
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-892-9813
Mailing Address - Street 1:947 S IRBY ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-5238
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2835 E HIGHWAY 76
Practice Address - Street 2:SUITE 7
Practice Address - City:MULLINS
Practice Address - State:SC
Practice Address - Zip Code:29574-6038
Practice Address - Country:US
Practice Address - Phone:843-431-2710
Practice Address - Fax:843-431-2716
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARION PHYSICIAN SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-06
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health