Provider Demographics
NPI:1063440014
Name:WILLIAM S MARSH III, DO, PA
Entity type:Organization
Organization Name:WILLIAM S MARSH III, DO, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:MARSH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:254-519-1900
Mailing Address - Street 1:PO BOX 11748
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76547-1748
Mailing Address - Country:US
Mailing Address - Phone:254-519-1900
Mailing Address - Fax:254-519-1980
Practice Address - Street 1:5320 E CENTRAL TEXAS EXPY STE 105
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76543-5516
Practice Address - Country:US
Practice Address - Phone:254-519-1900
Practice Address - Fax:254-519-1980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00437ROtherBLUE CROSS BLUE SHIELD
TX145079302Medicaid
TX00437ROtherBLUE CROSS BLUE SHIELD