1962824441 NPI number — MARSHALL MEDICAL CENTER SOUTH

Table of content: (NPI 1962824441)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962824441 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:
ORTHOPAEDIC ASSOC OF MARSHALL COUNTY
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:
1962824441
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2014
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# 2316
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35246-2316
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-571-8913
Provider Business Mailing Address Fax Number:
256-571-8918

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
38 ROWE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GUNTERSVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35976-7367
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-571-8913
Provider Business Practice Location Address Fax Number:
256-571-8918
Provider Enumeration Date:
01/17/2014

Additional Information

Authorized Official

Authorized Official Last Name:
NELSON
Authorized Official First Name:
KATHY
Authorized Official Middle Name:
B
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
256-571-8913

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 156252 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: DU6788 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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