Provider Demographics
NPI:1417514761
Name:MARQUIS HEALTH SOLUTION, LLC
Entity Type:Organization
Organization Name:MARQUIS HEALTH SOLUTION, LLC
Other - Org Name:MARQUIS HEALTH SOLUTION
Other - Org Type:Other Name
Authorized Official - Title/Position:CONTRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:UBINAS-BRACHE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:844-895-9030
Mailing Address - Street 1:14850 MONTFORT DR STE 197
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-6724
Mailing Address - Country:US
Mailing Address - Phone:844-895-9030
Mailing Address - Fax:833-272-5426
Practice Address - Street 1:14850 MONTFORT DR STE 197
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-6724
Practice Address - Country:US
Practice Address - Phone:844-895-9030
Practice Address - Fax:833-272-5426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-22
Last Update Date:2019-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1053453555OtherALL MEDICARES-COMMERCIAL