Healthcare Provider Details

I. General information

NPI: 1396229746
Provider Name (Legal Business Name): AVERA MARSHALL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2018
Last Update Date: 09/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 CARLSON ST STE 200
MARSHALL MN
56258-2626
US

IV. Provider business mailing address

1521 CARLSON ST STE 200
MARSHALL MN
56258-2626
US

V. Phone/Fax

Practice location:
  • Phone: 507-532-1901
  • Fax:
Mailing address:
  • Phone: 507-532-1901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHARON WILLIAMS
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 507-537-9150