Provider Demographics
NPI:1982878047
Name:FRED C. MARSH MD, PC
Entity type:Organization
Organization Name:FRED C. MARSH MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:C
Authorized Official - Last Name:MARSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:515-963-1827
Mailing Address - Street 1:2575 N ANKENY BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-4708
Mailing Address - Country:US
Mailing Address - Phone:515-963-1826
Mailing Address - Fax:515-963-1827
Practice Address - Street 1:2575 N ANKENY BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-4708
Practice Address - Country:US
Practice Address - Phone:515-963-1826
Practice Address - Fax:515-963-1827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA24273261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service