MEDICARE: MARSHALL MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	2084N0400X	Neurology Physician
2	2084P0800X	Psychiatry Physician
3	207QA0401X	Addiction Medicine (Family Medicine) Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073088316
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARSHALL MEDICAL CENTER

Provider Business Mailing Address
First Line	:	PO BOX 45680
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94145-0680
Country	:	US
Telephone Number	:	530-626-2787
Fax Number	:

Provider Business Practice Location Address
First Line	:	1045 MARSHALL WAY
Second Line	:
City	:	PLACERVILLE
State	:	CA
Zip	:	95667-5721
Country	:	US
Telephone Number	:	530-622-8204
Fax Number	:	530-622-8205

Authorized Official
Title or Position	:	CFO
Name	:	LAURIE ELDRIDGE
Credential	:
Telephone Number	:	530-622-1441

Provider Enumeration Date	:	10/12/2018
Last Update Date	:	09/08/2020

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Directions to “MARSHALL MEDICAL CENTER ” Practice Location

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