1164040986 NPI number — MARSHALL FAMILY MEDICINE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164040986 NPI number — MARSHALL FAMILY MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARSHALL FAMILY MEDICINE
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:
Provider Other Organization Name Type Code:
6
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:
1164040986
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/21/2025
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# 8241
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35246-8241
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-571-8500
Provider Business Mailing Address Fax Number:
256-571-8502

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
184 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARAB
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35016-1351
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-571-8500
Provider Business Practice Location Address Fax Number:
256-571-8502
Provider Enumeration Date:
07/08/2020

Additional Information

Authorized Official

Authorized Official Last Name:
WALKER
Authorized Official First Name:
TAYLOR
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
256-894-6600

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 255058 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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