Provider Demographics
NPI:1225313513
Name:MARSHALL MEDICAL CENTER NORTH FAMILY MEDICAL CENTER
Entity Type:Organization
Organization Name:MARSHALL MEDICAL CENTER NORTH FAMILY MEDICAL CENTER
Other - Org Name:MARSHALL MEDICAL CENTER NORTH FAMILY MEDICAL CENTER OF ARAB
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:B
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-894-6701
Mailing Address - Street 1:7938 AL HIGHWAY 69
Mailing Address - Street 2:SUITE 360
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976-7134
Mailing Address - Country:US
Mailing Address - Phone:256-571-8580
Mailing Address - Fax:256-571-8585
Practice Address - Street 1:7938 AL HIGHWAY 69
Practice Address - Street 2:SUITE 360
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976-7134
Practice Address - Country:US
Practice Address - Phone:256-571-8580
Practice Address - Fax:256-571-8585
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARSHALL MEDICAL CENTER NORTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-18
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.31188261QP2300X
261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1376718080OtherINDV NPI
AL1376718080OtherINDV NPI