Basic Information
| Provider Information | |||||||||
| NPI: | 1841240066 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MARSHALL TRUCK & TRAILER, INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | MARSHALL MOBILITY PLUS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 120 N 20TH ST | ||||||||
| Address2: | |||||||||
| City: | MCALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785016902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9569718646 | ||||||||
| FaxNumber: | 9566872281 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 N. 20TH ST. | ||||||||
| Address2: | |||||||||
| City: | MCALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9569718646 | ||||||||
| FaxNumber: | 9566872281 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 06/05/2008 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BIRD | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9569718646 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | 0054436 | TX | N | Suppliers | Durable Medical Equipment & Medical Supplies | 332BP3500X | TXD 0013052 | TX | N | Suppliers | Durable Medical Equipment & Medical Supplies | Parenteral & Enteral Nutrition | 332BC3200X | 0054436 | TX | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment |
ID Information
| ID | Type | State | Issuer | Description | 010125502 | 05 | TX | MEDICAID | 010125501 | 05 | TX | MEDICAID | 010125503 | 05 | TX | MEDICAID | 010125504 | 05 | TX | MEDICAID | 130398 | 01 | TX | TEXAS TRUE CHOICE | OTHER |