Provider Demographics
NPI:1093045742
Name:MARSHALL MEDICAL CENTER NORTH
Entity Type:Organization
Organization Name:MARSHALL MEDICAL CENTER NORTH
Other - Org Name:BRUNEAU OBGYN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRUNEAU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-571-8470
Mailing Address - Street 1:7938 AL HIGHWAY 69
Mailing Address - Street 2:SUITE 350
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976-7134
Mailing Address - Country:US
Mailing Address - Phone:256-571-8470
Mailing Address - Fax:256-571-8474
Practice Address - Street 1:7938 AL HIGHWAY 69
Practice Address - Street 2:SUITE 350
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976-7134
Practice Address - Country:US
Practice Address - Phone:256-571-8470
Practice Address - Fax:256-571-8474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-31
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty