Provider Demographics
NPI:1164040986
Name:MARSHALL FAMILY MEDICINE
Entity Type:Organization
Organization Name:MARSHALL FAMILY MEDICINE
Other - Org Name:MARSHALL PRIMARY CARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:M
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-894-6600
Mailing Address - Street 1:PO BOX 11407
Mailing Address - Street 2:DEPT# 8241
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-8241
Mailing Address - Country:US
Mailing Address - Phone:256-571-8500
Mailing Address - Fax:256-571-8502
Practice Address - Street 1:7938 ALABAMA HWY 69
Practice Address - Street 2:STE 350
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976-7135
Practice Address - Country:US
Practice Address - Phone:256-571-8500
Practice Address - Fax:256-571-8502
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HH HEALTH SYSTEM - MARSHALL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-08
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL255058Medicaid