Healthcare Provider Details

I. General information

NPI: 1427165729
Provider Name (Legal Business Name): MARION REGIONAL MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 11/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 SASSER DR
HAMILTON AL
35570-6621
US

IV. Provider business mailing address

184 SASSER DR
HAMILTON AL
35570-6621
US

V. Phone/Fax

Practice location:
  • Phone: 205-921-6340
  • Fax: 205-921-6345
Mailing address:
  • Phone: 205-921-6340
  • Fax: 205-921-6345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number12621
License Number StateAL

VIII. Authorized Official

Name: MR. JOSEPH A REPPERT
Title or Position: CFO
Credential:
Phone: 662-377-3978