Provider Demographics
NPI:1740372952
Name:MARBRIDGE FOUNDATION INC.
Entity type:Organization
Organization Name:MARBRIDGE FOUNDATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:P. DUNCAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-282-1811
Mailing Address - Street 1:PO BOX 2250
Mailing Address - Street 2:
Mailing Address - City:MANCHACA
Mailing Address - State:TX
Mailing Address - Zip Code:78652-2250
Mailing Address - Country:US
Mailing Address - Phone:512-282-1811
Mailing Address - Fax:512-381-2499
Practice Address - Street 1:2504 BLISS SPILLAR RD
Practice Address - Street 2:
Practice Address - City:MANCHACA
Practice Address - State:TX
Practice Address - Zip Code:78652-4409
Practice Address - Country:US
Practice Address - Phone:512-282-1000
Practice Address - Fax:512-381-2499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QH0700X, 261QP2000X, 261QX0100X, 313M00000X
TX9685314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX022766202OtherTPI MEDICARE PART B CROSS OVER
TX022766201Medicaid
TX000519101Medicaid
TX022766201Medicaid
TX1249620001Medicare NSC