Provider Demographics
NPI:1578734976
Name:MARION REGIONAL MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:MARION REGIONAL MEDICAL CENTER, INC.
Other - Org Name:MRMC ER PHYSICIANS
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: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, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-13
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALH4703261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL558800120Medicaid
AL051501210Medicaid
AL051501204Medicaid