Provider Demographics
NPI:1780677021
Name:CITY OF MARATHON A FLORIDA MUNICIPALITY
Entity type:Organization
Organization Name:CITY OF MARATHON A FLORIDA MUNICIPALITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACCESS MANAGER/BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HIRNEISEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-297-0440
Mailing Address - Street 1:PO BOX 5847
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30504-0847
Mailing Address - Country:US
Mailing Address - Phone:770-297-0440
Mailing Address - Fax:770-297-0550
Practice Address - Street 1:8900 OVERSEAS HWY
Practice Address - Street 2:
Practice Address - City:MARATHON
Practice Address - State:FL
Practice Address - Zip Code:33050-3227
Practice Address - Country:US
Practice Address - Phone:305-743-5266
Practice Address - Fax:305-289-9834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL27823416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL590015122OtherMEDICARE RAILROAD
FL590015122OtherMEDICARE RAILROAD
FL400094300Medicaid
FL=========OtherCHAMPUS