Healthcare Provider Details

I. General information

NPI: 1619616018
Provider Name (Legal Business Name): EDWARD MARSHALL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2022
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1065 SUNCREST TOWN CENTRE DR
MORGANTOWN WV
26505-1875
US

IV. Provider business mailing address

301 E TABERNACLE ST STE 201
ST GEORGE UT
84770-7129
US

V. Phone/Fax

Practice location:
  • Phone: 304-599-3959
  • Fax:
Mailing address:
  • Phone: 888-572-8389
  • Fax: 262-257-9921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: TRAVIS TOPHAM
Title or Position: CO-FOUNDER
Credential:
Phone: 888-572-8389