Healthcare Provider Details

I. General information

NPI: 1386065480
Provider Name (Legal Business Name): MARSHALL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2013
Last Update Date: 09/08/2020
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4341 GOLDEN CENTER DR SUITE A
PLACERVILLE CA
95667-6260
US

IV. Provider business mailing address

PO BOX 45680
SAN FRANCISCO CA
94145-0680
US

V. Phone/Fax

Practice location:
  • Phone: 530-626-1144
  • Fax:
Mailing address:
  • Phone: 530-626-2787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number030000059
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: LAURIE ELDRIDGE
Title or Position: CEO
Credential:
Phone: 530-626-2787