Provider Demographics
NPI:1407010416
Name:MARION REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:MARION REGIONAL MEDICAL CENTER
Other - Org Name:MRMC - ER PHY, CRNA, RADIOLOGIST
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS SERVICE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:KARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-921-6250
Mailing Address - Street 1:1256 MILITARY ST S
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:AL
Mailing Address - Zip Code:35570-5003
Mailing Address - Country:US
Mailing Address - Phone:205-921-6200
Mailing Address - Fax:205-921-6260
Practice Address - Street 1:1256 MILITARY ST S
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:AL
Practice Address - Zip Code:35570-5003
Practice Address - Country:US
Practice Address - Phone:205-921-6200
Practice Address - Fax:205-921-6260
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARION REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11841261QE0002X, 261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07929201Medicaid
ALI721OtherMEDICARE PHYSICIAN GROUP NUMBER