1225313513 NPI number — MARSHALL MEDICAL CENTER NORTH FAMILY MEDICAL CENTER

Table of content: (NPI 1225313513)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225313513 NPI number — MARSHALL MEDICAL CENTER NORTH FAMILY MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARSHALL MEDICAL CENTER NORTH FAMILY MEDICAL CENTER
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:
1225313513
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7938 AL HIGHWAY 69
Provider Second Line Business Mailing Address:
SUITE 360
Provider Business Mailing Address City Name:
GUNTERSVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35976-7134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-571-8580
Provider Business Mailing Address Fax Number:
256-571-8585

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7938 AL HIGHWAY 69
Provider Second Line Business Practice Location Address:
SUITE 360
Provider Business Practice Location Address City Name:
GUNTERSVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35976-7134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-571-8580
Provider Business Practice Location Address Fax Number:
256-571-8585
Provider Enumeration Date:
10/18/2011

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:
256-894-6701

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  MD.31188 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1376718080 . This is a "INDV NPI" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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