Provider Demographics
NPI:1578683090
Name:MARSHALL MEDICAL CENTER NORTH
Entity Type:Organization
Organization Name:MARSHALL MEDICAL CENTER NORTH
Other - Org Name:MEDICAL CENTER HOME HEALTH
Other - Org Type:Other Name
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 1:2307 HOMER CLAYTON DR
Mailing Address - Street 2:
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976-2205
Mailing Address - Country:US
Mailing Address - Phone:256-571-8003
Mailing Address - Fax:
Practice Address - Street 1:2307 HOMER CLAYTON DR
Practice Address - Street 2:
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976-2205
Practice Address - Country:US
Practice Address - Phone:256-571-8003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALH4804251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51043386OtherBCBS
ALMED7128AMedicaid
AL017128Medicare ID - Type Unspecified