MEDICARE: MARSHALL MEDICAL CENTER SOUTH DBA MMC RADIOLOGIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital	5834	AL

General Provider Information

NPI Number	:	1770872145
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARSHALL MEDICAL CENTER SOUTH DBA MMC RADIOLOGIST

Provider Business Mailing Address
First Line	:	DEPT 0406
Second Line	:	PO BOX 11407
City	:	BIRMINGHAM
State	:	AL
Zip	:	35246-0406
Country	:	US
Telephone Number	:	423-903-6796
Fax Number	:

Provider Business Practice Location Address
First Line	:	4198 US HIGHWAY 431
Second Line	:	SUITE B
City	:	ALBERTVILLE
State	:	AL
Zip	:	35950-0238
Country	:	US
Telephone Number	:	256-891-1226
Fax Number	:

Authorized Official
Title or Position	:	VP
Name	:	ANGELA PATTERSON
Credential	:
Telephone Number	:	423-903-6796

Provider Enumeration Date	:	04/06/2011
Last Update Date	:	04/06/2011

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