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DSH050254X MARSHALL HOSPITAL (Active)
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Main Details
Name
MARSHALL HOSPITAL
Subdivision Name
MARSHALL UROLOGY PLACERVILLE
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050254X
Medicare Provider Number
050254
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/11/2018
Participating Start Date
1/1/2019
Participating Approval Date
10/17/2018
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 SUITES 201 & 202
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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