MARVON SHANE HOLDAWAY, CM — NPI 1053045898 (Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center in MOUNT PLEASANT, UT)

CMS-1500 Box 24J / 33a • NPI

1053045898

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

261QR0405X (CMS D5)

Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center

Box 32 Service Location & ZIP+4

265 N STATE ST, MOUNT PLEASANT, UT, 84647-1108

✓ 9-Digit EDI 837 ZIP+4 (84647-1108)

Practice Phone & Referral Fax

(435) 462-2781

Fax: (435) 462-0155

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1053045898 (MARVON SHANE HOLDAWAY, CM) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1053045898` (NPI-1 Individual Practitioner)
Provider / Legal Name	MARVON SHANE HOLDAWAY, CM
Plain-English Specialty	Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center NUCC Code: `261QR0405X` (Clinic/Center, Rehabilitation, Substance Use Disorder)
Certifying / Licensing Body	Accreditation Association for Ambulatory Health Care (AAAHC) / CMS
Practice Location Address	265 N STATE ST, MOUNT PLEASANT, UT, 84647-1108
Practice Telephone / Fax	Tel: (435) 462-2781 \| Fax: (435) 462-0155
Administrative Mailing Address	PO BOX 31, MT PLEASANT, UT, 84647-0031
Enumeration & Last Sync	Enumerated: 2022-07-15 \| CMS Record Updated: 2022-07-18

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

265 N STATE ST, MOUNT PLEASANT, UT, 84647-1108

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Plain-English Taxonomy & CMS Crosswalk (261QR0405X)

What Does Taxonomy Code 261QR0405X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 261QR0405X translates to:
"Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center"

CMS-1500 Medicare Specialty Crosswalk: CMS Code D5 (Opioid Treatment Program)
Certifying / Accrediting Authority: Accreditation Association for Ambulatory Health Care (AAAHC) / CMS
Clinical Scope: Same-day outpatient consultations, urgent walk-in medical care, vaccinations, and day-case diagnostic procedures.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (MARVON SHANE HOLDAWAY, CM)

Typical CPT / Diagnostic Procedures:

Walk-In Urgent Care Evaluation, Point-of-Care Testing & X-Ray
Same-Day Ambulatory Endoscopy, Cataract & Minor Surgical Procedures

Common Therapeutic Classes:

Outpatient Oral Antimicrobials, Analgesics, Nebulizers & Vaccines

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`261QR0405X` — Clinic/Center, Rehabilitation, Substance Use Disorder Plain English: Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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MARVON SHANE HOLDAWAY, CM (NPI #1053045898)