Healthcare Provider Details

I. General information

NPI: 1295972594
Provider Name (Legal Business Name): THE MARSHALL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2009
Last Update Date: 01/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3818 SW 21ST PL STE 100
REDMOND OR
97756-6801
US

IV. Provider business mailing address

PO BOX 1770
REDMOND OR
97756-0519
US

V. Phone/Fax

Practice location:
  • Phone: 541-548-2899
  • Fax: 541-504-3781
Mailing address:
  • Phone: 541-923-4576
  • Fax: 541-923-4002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateOR

VIII. Authorized Official

Name: SHERREL A STEPHENS
Title or Position: DELEGATED OFFICIAL
Credential:
Phone: 541-504-6315