=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801200191
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARSH FAMILY MEDICINE, PLLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2014
-----------------------------------------------------
Last Update Date | 08/31/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7440 N ORACLE RD # 7
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85704-6385
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-797-5603
-----------------------------------------------------
Fax | 520-638-5574
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7740 N ORACLE RD BUILDING # 7
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85704-6313
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-797-5603
-----------------------------------------------------
Fax | 520-638-5574
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | STATUTORY AGENT
-----------------------------------------------------
Name | DR. CHRISTOPHER LYNCH MARSH
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 520-797-5603
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207QA0505X
-----------------------------------------------------
Taxonomy Name | Adult Medicine Physician
-----------------------------------------------------
License Number | AZ2532
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------