Provider Demographics
NPI:1528070414
Name:MARSHALL FAMILY PRACTICE ASSOCIATES PLLC
Entity type:Organization
Organization Name:MARSHALL FAMILY PRACTICE ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TOLESIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-935-9110
Mailing Address - Street 1:402 S BOLIVAR ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75670-4110
Mailing Address - Country:US
Mailing Address - Phone:903-935-9100
Mailing Address - Fax:903-935-9102
Practice Address - Street 1:402 S BOLIVAR ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670-4110
Practice Address - Country:US
Practice Address - Phone:903-935-9100
Practice Address - Fax:903-935-9102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
00W843Medicare PIN