Provider Demographics
NPI:1528023579
Name:MARION REGIONAL MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:MARION REGIONAL MEDICAL CENTER, INC.
Other - Org Name:MARION REGIONAL MEDICAL CENTER HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:REPPERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-377-3978
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:662-377-2138
Mailing Address - Fax:662-377-7983
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:662-377-2138
Practice Address - Fax:662-377-7983
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARION REGIONAL MEDICAL CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-20
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALH4703251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
017100Medicare Oscar/Certification