Provider Demographics
NPI: | 1003136896 |
---|---|
Name: | MARSHALL MEDICAL CENTER SOUTH |
Entity Type: | Organization |
Organization Name: | MARSHALL MEDICAL CENTER SOUTH |
Other - Org Name: | WILLIS SURGICAL |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CFO |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | KATHY |
Authorized Official - Middle Name: | B |
Authorized Official - Last Name: | NELSON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | CPA |
Authorized Official - Phone: | 256-894-6600 |
Mailing Address - Street 1: | 133 WALL ST |
Mailing Address - Street 2: | |
Mailing Address - City: | ALBERTVILLE |
Mailing Address - State: | AL |
Mailing Address - Zip Code: | 35951-9300 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 256-840-5547 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 133 WALL ST |
Practice Address - Street 2: | |
Practice Address - City: | ALBERTVILLE |
Practice Address - State: | AL |
Practice Address - Zip Code: | 35951-9300 |
Practice Address - Country: | US |
Practice Address - Phone: | 256-840-5547 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | MARSHALL MEDICAL CENTER SOUTH |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2010-06-03 |
Last Update Date: | 2010-06-03 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 2086S0129X | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | Group - Single Specialty |