Basic Information
| Provider Information | |||||||||
| NPI: | 1710140520 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARSHALL MEDICAL CENTER NORTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8000 AL HIGHWAY 69 | ||||||||
| Address2: | |||||||||
| City: | GUNTERSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 359767140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565718000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8000 AL HIGHWAY 69 | ||||||||
| Address2: | |||||||||
| City: | GUNTERSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 359767140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565718000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2008 | ||||||||
| LastUpdateDate: | 08/08/2012 | ||||||||
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| AuthorizedOfficialLastName: | NELSON | ||||||||
| AuthorizedOfficialFirstName: | KATHY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 2568946600 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MARSHALL MEDICAL CENTER NORTH | ||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | CPA | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 341600000X | Y | Transportation Services | Ambulance |
ID Information
| ID | Type | State | Issuer | Description | 200048110 | 05 | AL | MEDICAID |