Provider Demographics
NPI:1447912191
Name:MARSHALL MEDICAL CENTER
Entity type:Organization
Organization Name:MARSHALL MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELDRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-626-2780
Mailing Address - Street 1:1100 MARSHALL WAY
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-6533
Mailing Address - Country:US
Mailing Address - Phone:530-626-2789
Mailing Address - Fax:
Practice Address - Street 1:3581 PALMER DR STE 601
Practice Address - Street 2:
Practice Address - City:CAMERON PARK
Practice Address - State:CA
Practice Address - Zip Code:95682-8238
Practice Address - Country:US
Practice Address - Phone:530-344-5423
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARSHALL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-11
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy