Provider Demographics
NPI:1104149442
Name:MARSHALL MEDICAL CENTER NORTH
Entity type:Organization
Organization Name:MARSHALL MEDICAL CENTER NORTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
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:P.O. BOX 11407
Mailing Address - Street 2:DEPT #0132
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-0132
Mailing Address - Country:US
Mailing Address - Phone:256-728-8600
Mailing Address - Fax:256-728-8602
Practice Address - Street 1:4500 MAIN ST
Practice Address - Street 2:
Practice Address - City:GRANT
Practice Address - State:AL
Practice Address - Zip Code:35747-8303
Practice Address - Country:US
Practice Address - Phone:256-728-8600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARSHALL MEDICAL CENTER NORTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-01
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty