MEDICARE: MARSHALL MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0855X	Adolescent and Children Mental Health Clinic/Center
2	261QM0850X	Adult Mental Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356904577
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARSHALL MEDICAL CENTER

Provider Business Mailing Address
First Line	:	PO BOX 45680
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94145-0680
Country	:	US
Telephone Number	:	530-626-2618
Fax Number	:

Provider Business Practice Location Address
First Line	:	3581 PALMER DR STE 202
Second Line	:
City	:	CAMERON PARK
State	:	CA
Zip	:	95682-8237
Country	:	US
Telephone Number	:	530-672-7000
Fax Number	:

Authorized Official
Title or Position	:	PROVIDER CREDENTIALING
Name	:	KIM SANGUINETTI-WEISHAAR
Credential	:
Telephone Number	:	530-626-2770

Provider Enumeration Date	:	04/15/2019
Last Update Date	:	04/15/2019

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Directions to “MARSHALL MEDICAL CENTER ” Practice Location

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