# MARION DIAGNOSTIC CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366543084
- **Authorized official:** MR. JAY CARTER (OFFICE ADMINISTRATOR)
- **Authorized official phone:** (618) 993-1400

## Contact information

- **Practice address:** 3003 CIVIC CIRCLE BLVD SUITE 200, MARION, IL 62959-5259
- **Practice address phone:** (618) 993-1400
- **Practice address fax:** (618) 993-1522
- **Mailing address:** 3003 CIVIC CIRCLE BLVD SUITE 200, MARION, IL 62959-5259
- **Mailing address phone:** (618) 993-1400
- **Mailing address fax:** (618) 993-1522

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207P00000X | Emergency Medicine Physician | — | NULL | — |
| 207P00000X | Emergency Medicine Physician | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207RG0100X | Gastroenterology Physician | — | NULL | — |
| 207RG0100X | Gastroenterology Physician | — | — | — |
| 207RH0003X | Hematology & Oncology Physician | — | NULL | — |
| 207RH0003X | Hematology & Oncology Physician | — | — | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | — |
| 207Y00000X | Otolaryngology Physician | — | NULL | — |
| 207Y00000X | Otolaryngology Physician | — | — | — |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |
| 208600000X | Surgery Physician | — | NULL | — |
| 208600000X | Surgery Physician | — | — | — |
| 208800000X | Urology Physician | — | NULL | — |
| 208800000X | Urology Physician | — | — | — |
| 213E00000X | Podiatrist | — | NULL | — |
| 213E00000X | Podiatrist | — | — | — |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |
| 261QR0200X | Radiology Clinic/Center | — | NULL | — |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | — |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 09/26/2006
- **Last updated:** 09/08/2022