Provider Demographics
NPI:1750734232
Name:PUSH CONCIERGE MEDICINE, PLLC
Entity type:Organization
Organization Name:PUSH CONCIERGE MEDICINE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARSHALL
Authorized Official - Middle Name:
Authorized Official - Last Name:NICKEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-985-3501
Mailing Address - Street 1:50 W BROADWAY STE 333 #164321
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84101-2027
Mailing Address - Country:US
Mailing Address - Phone:801-709-1470
Mailing Address - Fax:253-218-6964
Practice Address - Street 1:50 W BROADWAY STE 333 #164321
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84101-2027
Practice Address - Country:US
Practice Address - Phone:801-709-1470
Practice Address - Fax:253-218-6964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-19
Last Update Date:2025-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty