Provider Demographics
NPI:1043428345
Name:MARSHALL HEALTHCARE SYSTEMS INC
Entity Type:Organization
Organization Name:MARSHALL HEALTHCARE SYSTEMS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GRANVILLE
Authorized Official - Middle Name:H
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:530-313-5529
Mailing Address - Street 1:170 RUSSELL AVE
Mailing Address - Street 2:SUITE L
Mailing Address - City:SUSANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96130-4282
Mailing Address - Country:US
Mailing Address - Phone:530-313-5529
Mailing Address - Fax:530-387-3581
Practice Address - Street 1:170 RUSSELL AVE
Practice Address - Street 2:SUITE L
Practice Address - City:SUSANVILLE
Practice Address - State:CA
Practice Address - Zip Code:96130-4282
Practice Address - Country:US
Practice Address - Phone:530-313-5529
Practice Address - Fax:530-387-3581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70232207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH 12554Medicare UPIN