MEDICARE: AVERA MARSHALL

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	0032355	MN

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	:	1255329033
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVERA MARSHALL

Provider Business Mailing Address
First Line	:	300 S BRUCE ST
Second Line	:
City	:	MARSHALL
State	:	MN
Zip	:	56258-1934
Country	:	US
Telephone Number	:	507-537-9160
Fax Number	:	507-537-9144

Provider Business Practice Location Address
First Line	:	300 S BRUCE ST
Second Line	:
City	:	MARSHALL
State	:	MN
Zip	:	56258-1934
Country	:	US
Telephone Number	:	507-537-9160
Fax Number	:	507-537-9144

Authorized Official
Title or Position	:	CEO
Name	:	DEBBIE STREIER
Credential	:
Telephone Number	:	507-537-9160

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	12/02/2022

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Directions to “AVERA MARSHALL ” Practice Location

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