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  7. NPI Record 1710925045

MARION INDEPENDENT PHYSICIANS ASSOCIATION, LLC
Complete NPI Record 1710925045
Family Medicine in Marion, OH

NPI Status: Active since June 02, 2006

Contact Information

30D EXECUTIVE DRIVE
MARION, OH
ZIP 43302
Phone: (740) 387-7793
Fax: (740) 387-7795

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider First Line Business Mailing Address
  6. Provider Business Mailing Address City Name
  7. Provider Business Mailing Address State Name
  8. Provider Business Mailing Address Postal Code
  9. Provider Business Mailing Address Country Code If outside U S
  10. Provider Business Mailing Address Telephone Number
  11. Provider Business Mailing Address Fax Number
  12. Provider First Line Business Practice Location Address
  13. Provider Business Practice Location Address City Name
  14. Provider Business Practice Location Address State Name
  15. Provider Business Practice Location Address Postal Code
  16. Provider Business Practice Location Address Country Code If outside U S
  17. Provider Business Practice Location Address Telephone Number
  18. Provider Business Practice Location Address Fax Number
  19. Provider Enumeration Date
  20. Last Update Date
  21. Authorized Official Last Name
  22. Authorized Official First Name
  23. Authorized Official Title or Position
  24. Authorized Official Telephone Number
  25. Healthcare Provider Taxonomy Code 1
  26. Healthcare Provider Primary Taxonomy Switch 1
  27. Healthcare Provider Taxonomy Code 2
  28. Healthcare Provider Primary Taxonomy Switch 2
  29. Healthcare Provider Taxonomy Code 3
  30. Healthcare Provider Primary Taxonomy Switch 3
  31. Healthcare Provider Taxonomy Code 4
  32. Healthcare Provider Primary Taxonomy Switch 4
  33. Healthcare Provider Taxonomy Code 5
  34. Healthcare Provider Primary Taxonomy Switch 5
  35. Healthcare Provider Taxonomy Code 6
  36. Healthcare Provider Primary Taxonomy Switch 6
  37. Healthcare Provider Taxonomy Code 7
  38. Healthcare Provider Primary Taxonomy Switch 7
  39. Healthcare Provider Taxonomy Code 8
  40. Healthcare Provider Primary Taxonomy Switch 8
  41. Healthcare Provider Taxonomy Code 9
  42. Healthcare Provider Primary Taxonomy Switch 9
  43. Healthcare Provider Taxonomy Code 10
  44. Healthcare Provider Primary Taxonomy Switch 10
  45. Healthcare Provider Taxonomy Code 11
  46. Healthcare Provider Primary Taxonomy Switch 11
  47. Healthcare Provider Taxonomy Code 12
  48. Healthcare Provider Primary Taxonomy Switch 12
  49. Healthcare Provider Taxonomy Code 13
  50. Healthcare Provider Primary Taxonomy Switch 13
  51. Healthcare Provider Taxonomy Code 14
  52. Healthcare Provider Primary Taxonomy Switch 14
  53. Healthcare Provider Taxonomy Code 15
  54. Healthcare Provider Primary Taxonomy Switch 15
  55. Other Provider Identifier 1
  56. Other Provider Identifier Type Code 1
  57. Other Provider Identifier State 1
  58. Other Provider Identifier 2
  59. Other Provider Identifier Type Code 2
  60. Other Provider Identifier State 2
  61. Other Provider Identifier 3
  62. Other Provider Identifier Type Code 3
  63. Other Provider Identifier State 3
  64. Other Provider Identifier 4
  65. Other Provider Identifier Type Code 4
  66. Other Provider Identifier State 4
  67. Other Provider Identifier 5
  68. Other Provider Identifier Type Code 5
  69. Other Provider Identifier State 5
  70. Other Provider Identifier 6
  71. Other Provider Identifier Type Code 6
  72. Other Provider Identifier State 6
  73. Other Provider Identifier 7
  74. Other Provider Identifier Type Code 7
  75. Other Provider Identifier State 7
  76. Other Provider Identifier 8
  77. Other Provider Identifier Type Code 8
  78. Other Provider Identifier State 8
  79. Other Provider Identifier 9
  80. Other Provider Identifier Type Code 9
  81. Other Provider Identifier State 9
  82. Other Provider Identifier 10
  83. Other Provider Identifier Type Code 10
  84. Other Provider Identifier State 10
  85. Other Provider Identifier 11
  86. Other Provider Identifier Type Code 11
  87. Other Provider Identifier State 11
  88. Other Provider Identifier 12
  89. Other Provider Identifier Type Code 12
  90. Other Provider Identifier State 12
  91. Other Provider Identifier 13
  92. Other Provider Identifier Type Code 13
  93. Other Provider Identifier State 13
  94. Other Provider Identifier 14
  95. Other Provider Identifier Type Code 14
  96. Other Provider Identifier State 14
  97. Is Organization Subpart
  98. Parent Organization LBN
  99. Parent Organization TIN
  100. Healthcare Provider Taxonomy Group 1
  101. Healthcare Provider Taxonomy Group 2
  102. Healthcare Provider Taxonomy Group 3
  103. Healthcare Provider Taxonomy Group 4
  104. Healthcare Provider Taxonomy Group 5
  105. Healthcare Provider Taxonomy Group 6
  106. Healthcare Provider Taxonomy Group 7
  107. Healthcare Provider Taxonomy Group 8
  108. Healthcare Provider Taxonomy Group 9
  109. Healthcare Provider Taxonomy Group 10
  110. Healthcare Provider Taxonomy Group 11
  111. Healthcare Provider Taxonomy Group 12
  112. Healthcare Provider Taxonomy Group 13
  113. Healthcare Provider Taxonomy Group 14
  114. Healthcare Provider Taxonomy Group 15
  115. NPI Certification Date

Complete NPI Dataset

This page represents the complete record for NPI 1710925045. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1710925045
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 2
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: UNAVAIL
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider First Line Business Mailing Address: P.O. BOX 887
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City Name: MARION
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: OH
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 433010887
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 7402233496
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number: 7403836463
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address: 30D EXECUTIVE DRIVE
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: MARION
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: OH
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 433026310
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 7403877793
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 7403877795
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 6/2/2006
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 6/28/2021
The date that a record was last updated or changed.
Authorized Official Last Name: RAVI
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: SRINIVAS
The first name of the authorized official.
Authorized Official Title or Position: MD
The title or position of the authorized official.
Authorized Official Telephone Number: 7403877793
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 133V00000X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 1: N
Healthcare Provider Taxonomy Code 2: 207L00000X
Healthcare Provider Primary Taxonomy Switch 2: N
Healthcare Provider Taxonomy Code 3: 207Q00000X
Healthcare Provider Primary Taxonomy Switch 3: Y
Healthcare Provider Taxonomy Code 4: 207R00000X
Healthcare Provider Primary Taxonomy Switch 4: N
Healthcare Provider Taxonomy Code 5: 207RC0000X
Healthcare Provider Primary Taxonomy Switch 5: N
Healthcare Provider Taxonomy Code 6: 207RH0003X
Healthcare Provider Primary Taxonomy Switch 6: N
Healthcare Provider Taxonomy Code 7: 207X00000X
Healthcare Provider Primary Taxonomy Switch 7: N
Healthcare Provider Taxonomy Code 8: 2084N0400X
Healthcare Provider Primary Taxonomy Switch 8: N
Healthcare Provider Taxonomy Code 9: 2084P0800X
Healthcare Provider Primary Taxonomy Switch 9: N
Healthcare Provider Taxonomy Code 10: 208600000X
Healthcare Provider Primary Taxonomy Switch 10: N
Healthcare Provider Taxonomy Code 11: 208800000X
Healthcare Provider Primary Taxonomy Switch 11: N
Healthcare Provider Taxonomy Code 12: 213E00000X
Healthcare Provider Primary Taxonomy Switch 12: N
Healthcare Provider Taxonomy Code 13: 225100000X
Healthcare Provider Primary Taxonomy Switch 13: N
Healthcare Provider Taxonomy Code 14: 363A00000X
Healthcare Provider Primary Taxonomy Switch 14: N
Healthcare Provider Taxonomy Code 15: 363L00000X
Healthcare Provider Primary Taxonomy Switch 15: N
Other Provider Identifier 1: 2105288
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 1: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 1: OH
Other Provider Identifier 2: 2105322
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 2: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 2: OH
Other Provider Identifier 3: 2104136
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 3: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 3: OH
Other Provider Identifier 4: 2105242
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 4: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 4: OH
Other Provider Identifier 5: 2105411
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 5: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 5: OH
Other Provider Identifier 6: 2104127
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 6: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 6: OH
Other Provider Identifier 7: 2105331
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 7: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 7: OH
Other Provider Identifier 8: 2105359
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 8: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 8: OH
Other Provider Identifier 9: 2105224
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 9: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 9: OH
Other Provider Identifier 10: 2105279
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 10: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 10: OH
Other Provider Identifier 11: 2105386
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 11: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 11: OH
Other Provider Identifier 12: 2105475
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 12: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 12: OH
Other Provider Identifier 13: 2105251
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 13: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 13: OH
Other Provider Identifier 14: 2105519
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 14: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 14: OH
Is Organization Subpart: Y
Parent Organization LBN: MARION INDEPENDENT PHYSICIANS ASSOCIATION, LLC
Parent Organization TIN: UNAVAIL
Healthcare Provider Taxonomy Group 1: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 2: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 3: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 4: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 5: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 6: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 7: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 8: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 9: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 10: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 11: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 12: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 13: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 14: 193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 15: 193200000X MULTI-SPECIALTY GROUP
NPI Certification Date: 6/28/2021