Provider Demographics
NPI:1740295542
Name:MARSHALL FAMILY HEALTH CLINIC
Entity type:Organization
Organization Name:MARSHALL FAMILY HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-894-6615
Mailing Address - Street 1:227 BRITTANY RD
Mailing Address - Street 2:
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976-5766
Mailing Address - Country:US
Mailing Address - Phone:256-891-3144
Mailing Address - Fax:256-878-1742
Practice Address - Street 1:5930 HWY 431
Practice Address - Street 2:SUITE 2
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35950
Practice Address - Country:US
Practice Address - Phone:256-878-1053
Practice Address - Fax:256-878-1742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL541003902Medicaid
AL529704170Medicaid
ALI561OtherMEDICARE GROUP NUMBER
AL013902Medicare Oscar/Certification
ALI561OtherMEDICARE GROUP NUMBER
AL051529917Medicare Oscar/Certification