Healthcare Provider Details

I. General information

NPI: 1104149442
Provider Name (Legal Business Name): MARSHALL MEDICAL CENTER NORTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2010
Last Update Date: 03/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 MAIN ST
GRANT AL
35747-8303
US

IV. Provider business mailing address

P.O. BOX 11407 DEPT #0132
BIRMINGHAM AL
35246-0132
US

V. Phone/Fax

Practice location:
  • Phone: 256-728-8600
  • Fax:
Mailing address:
  • Phone: 256-728-8600
  • Fax: 256-728-8602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. KATHY B NELSON
Title or Position: CFO
Credential: CPA
Phone: 256-894-6600