1326116880 NPI number — MARSHALL MEDICAL CENTER SOUTH

Table of content: (NPI 1326116880)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326116880 NPI number — MARSHALL MEDICAL CENTER SOUTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARSHALL MEDICAL CENTER SOUTH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ALBERTVILLE PRIMARY CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326116880
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11407
Provider Second Line Business Mailing Address:
DEPT #1557
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35246-1557
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-894-7795
Provider Business Mailing Address Fax Number:
256-894-6471

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2505 US HWY 431
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOAZ
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35957
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-894-7795
Provider Business Practice Location Address Fax Number:
256-894-6471
Provider Enumeration Date:
12/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CALHOUN
Authorized Official First Name:
GARY
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
256-894-7795

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  15304 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: J340 . This is a "MEDICARE GROUP" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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