Provider Demographics
NPI:1962824441
Name:MARSHALL MEDICAL CENTER SOUTH
Entity Type:Organization
Organization Name:MARSHALL MEDICAL CENTER SOUTH
Other - Org Name:ORTHOPAEDIC ASSOC OF MARSHALL COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:B
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-571-8913
Mailing Address - Street 1:PO BOX 11407
Mailing Address - Street 2:DEPT# 2316
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-2316
Mailing Address - Country:US
Mailing Address - Phone:256-571-8913
Mailing Address - Fax:256-571-8918
Practice Address - Street 1:38 ROWE DR
Practice Address - Street 2:
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976-7367
Practice Address - Country:US
Practice Address - Phone:256-571-8913
Practice Address - Fax:256-571-8918
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARSHALL MEDICAL CENTER SOUTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-17
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL156252Medicaid
ALDU6788OtherRAILROAD MEDICARE
AL102G704399Medicare PIN