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NPI Code Detail

MEDICARE: MARSHALL EL DORADO ENDSCOPY CENTER

MEDICARE: MARSHALL EL DORADO ENDSCOPY CENTER
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
1261QE0800XEndoscopy Clinic/CenterZZZ25449ZCA

General Provider Information

NPI Number : 1629142708
Entity Type Code : Organization
Provider Name (Legal Business Name) : MARSHALL EL DORADO ENDSCOPY CENTER
Provider Business Mailing Address
First Line : 1000 FOWLER WAY STE 6
Second Line :
City : PLACERVILLE
State : CA
Zip : 95667-5738
Country : US
Telephone Number : 530-626-2789
Fax Number : 530-626-2833
Provider Business Practice Location Address
First Line : 1100 MARSHALL WAY
Second Line : ATTN KAREN D BILLING
City : PLACERVILLE
State : CA
Zip : 95667-6533
Country : US
Telephone Number : 530-626-2789
Fax Number : 530-626-2833
Authorized Official
Title or Position : CEO
Name : MR. JAMES WHIPPLE
Credential :
Telephone Number : 530-622-1441
Provider Enumeration Date : 11/20/2006
Last Update Date : 08/22/2020

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