Provider Demographics
NPI:1639321789
Name:MARSHALL MEDICAL CENTER SOUTH
Entity Type:Organization
Organization Name:MARSHALL MEDICAL CENTER SOUTH
Other - Org Name:MEDICAL CENTER OBGYN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:M
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-894-6600
Mailing Address - Street 1:2525 US HIGHWAY 431
Mailing Address - Street 2:210
Mailing Address - City:BOAZ
Mailing Address - State:AL
Mailing Address - Zip Code:35957-5934
Mailing Address - Country:US
Mailing Address - Phone:256-840-4601
Mailing Address - Fax:256-840-4613
Practice Address - Street 1:2525 US HIGHWAY 431
Practice Address - Street 2:210
Practice Address - City:BOAZ
Practice Address - State:AL
Practice Address - Zip Code:35957-5934
Practice Address - Country:US
Practice Address - Phone:256-840-4601
Practice Address - Fax:256-840-4613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL28483207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1114948270OtherNPI INDIVIDUAL
AL1114948270OtherNPI INDIVIDUAL