Marshall Medical Center
Organization Active NPI Adult Mental Health Clinic/Center · Cameron Park, CA
NPI 1356904577 · NPPES record last updated Apr 15, 2019
Key facts
- NPI
- 1356904577
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Adult Mental Health Clinic/Center 261QM0850X
- Legal business name
- MARSHALL MEDICAL CENTER
- Practice address
- 3581 Palmer Dr Ste 202
Cameron Park, CA 95682-8237 - Phone
- (530) 672-7000
- NPI assigned
- Apr 15, 2019
- Organization subpart
- No
Authorized official
- Name
- Kim Sanguinetti-Weishaar
- Title
- Provider Credentialing
- Phone
- (530) 626-2770
Other NPIs on the same Medicare enrollment 14
Corporate family (same tax ID) 17
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031208001095 | CA | Part B Supplier - Clinic/Group Practice | 7517875859 |
Receives reassigned benefits from 169 practitioners 14 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Placerville, CA; Twin Bridges, CA; Gold River, CA; El Dorado Hills, CA; Cameron Park, CA |
National Provider Directory
- Tax ID family
- Marshall Ctr for Primar
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Mental Health Clinic/Center | 261QM0850X | Yes | ||
| Adolescent and Children Mental Health Clinic/Center | 261QM0855X |
Addresses
Primary practice location
3581 Palmer Dr Ste 202
Cameron Park, CA 95682-8237
Mailing address
PO Box 45680
San Francisco, CA 94145-0680
Phone (530) 626-2618
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ZZZ00439Z | Medicaid | CA |
Other names
- Marshall Psychiatry
Other providers in Cameron Park, CA
- Joshua James Manley
- Mark Mansour
- Mark Blatt Associates, Inc
- Makenna Marrs
- Marshall Medical Center
- Marshall Medical Center
- Marshall Medical Center
- Marshall Medical Center
- Marshall Medical Center
- Marshall Surgery Center, LLC
All providers in Cameron Park, CA · Adult Mental Health Clinic/Center in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 15, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.