Provider Demographics
NPI:1558524363
Name:MARSHALL MEDICAL CENTER NORTH
Entity Type:Organization
Organization Name:MARSHALL MEDICAL CENTER NORTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:B
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:256-894-6600
Mailing Address - Street 1:8000 AL HIGHWAY 69
Mailing Address - Street 2:
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976-7140
Mailing Address - Country:US
Mailing Address - Phone:256-571-8000
Mailing Address - Fax:
Practice Address - Street 1:8000 AL HIGHWAY 69
Practice Address - Street 2:
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976-7140
Practice Address - Country:US
Practice Address - Phone:256-571-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARSHALL MEDICAL CENTER NORTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207P00000X, 207Q00000X, 207R00000X
ALH4804282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No282N00000XHospitalsGeneral Acute Care HospitalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL558200060Medicaid
AL559100110Medicaid