Marshall Family Practice Associates PLLC
Organization Active NPI Preferred Provider Organization · Marshall, TX
NPI 1528070414 · NPPES record last updated Feb 12, 2008
Key facts
- NPI
- 1528070414
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Preferred Provider Organization 305R00000X
- Legal business name
- MARSHALL FAMILY PRACTICE ASSOCIATES PLLC
- Practice address
- 402 S Bolivar St
Marshall, TX 75670-4110 - Phone
- (903) 935-9100
- Fax
- (903) 935-9102
- NPI assigned
- Aug 12, 2006
- Organization subpart
- No
Authorized official
- Name
- Tolesia Smith
- Title
- Office Manager
- Phone
- (903) 935-9110
Practitioners 6
-
James Logan, MD
-
Tia Roche Ivory, FNP-C
-
Jasmine Johnson, FNP-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 45D2146439 | Marshall Family Practice | Certificate of waiver | Mar 28, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20061027000116 | TX | Part B Supplier - Clinic/Group Practice | 6901803303 |
Receives reassigned benefits from 6 practitioners Practice locations: Marshall, TX |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Preferred Provider Organization | 305R00000X | Yes |
Addresses
Primary practice location
402 S Bolivar St
Marshall, TX 75670-4110
Mailing address
402 S Bolivar St
Marshall, TX 75670-4110
Phone (903) 935-9100
Other providers in Marshall, TX
- Marhall Opco, LLC
- Marshall Anesthesia Services, PA
- Marshall Dental Association
- Marshall Dental PC
- Marshall Family Dental PLLC
- Marshall Gastroenterology, P.a.
- Marshall Health Services Inc
- Marshall Homecare, LLC
- Marshall Hospitalist
- Marshall Internal Medicine Associates
All providers in Marshall, TX · Preferred Provider Organization in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 12, 2008. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.