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DSH050254T MARSHALL HOSPITAL (Active)
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Main Details
Name
MARSHALL HOSPITAL
Subdivision Name
MARSHALL FAMILY MEDICINE PLACERVILLE
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050254T
Medicare Provider Number
050254
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/5/2016
Participating Start Date
4/1/2016
Participating Approval Date
3/1/2016
Last Recertification Date
8/12/2024
Contacts
Authorizing Official
Marshall Medical Center
Siri Nelson, CEO
(707) 349-8127
Primary Contact
Marshall Medical Center
Stephanie A Godon, Director of Pharmacy
(530) 626-2703
Addresses
Street Address
1095 MARSHALL WAY, SUITE 100
PLACERVILLE, CA 95667
Billing Address
Marshall Medical Center
1100 Marshall Way
Placerville, CA 95667
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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