NPIMap

Organization Active NPI

Marshall Medical Center South Manganaris Pulmonology

  • Pulmonary Disease Physician
  • Guntersville, AL
National Provider Identifier
1013299304
Registry record updated Sep 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
MD30912 Issued in AL
Legal business name
MARSHALL MEDICAL CENTER SOUTH MANGANARIS PULMONOLOGY
Practice address
55 Rowe Dr
Suite C
Guntersville, AL 35976-7366
Phone
(256) 753-8810
Fax
(256) 753-8880
NPI assigned
Sep 13, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Gwen L Gunn
Title
Administrator
Phone
(256) 753-8810

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RP1001X MD30912 AL Primary

Addresses

Primary practice location

55 Rowe Dr
Suite C
Guntersville, AL 35976-7366

Mailing address

55 Rowe Dr
Suite C
Guntersville, AL 35976-7366
Phone (256) 753-8810

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120405000090 AL Part B Supplier - Clinic/Group Practice 5092976787 Receives reassigned benefits from 7 practitioners
Practice locations: Albertville, AL; Birmingham, AL; Boaz, AL; Guntersville, AL

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

11491 US Highway 431
Ste F
Albertville, AL 35950
Phone (256) 894-6910

2525 Us Hwy 431
Ste 210
Birmingham, AL 35246

2525 US Highway 431
Ste 150
Boaz, AL 35957
Phone (256) 593-4560

7938 AL Highway 69
Ste 210
Guntersville, AL 35976
Phone (256) 571-8807

55 Rowe Dr
#C
Guntersville, AL 35976
Phone (256) 571-8810

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1315872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1315872000000",
    "number": "1013299304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 ROWE DR",
            "address_2": "SUITE C",
            "city": "GUNTERSVILLE",
            "state": "AL",
            "postal_code": "359767366",
            "telephone_number": "256-753-8810",
            "fax_number": "256-753-8880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 ROWE DR",
            "address_2": "SUITE C",
            "city": "GUNTERSVILLE",
            "state": "AL",
            "postal_code": "359767366",
            "telephone_number": "256-753-8810",
            "fax_number": "256-753-8880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARSHALL MEDICAL CENTER SOUTH MANGANARIS PULMONOLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-13",
        "last_updated": "2011-09-13",
        "status": "A",
        "authorized_official_last_name": "GUNN",
        "authorized_official_first_name": "GWEN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "256-753-8810"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "AL",
            "license": "MD30912",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Guntersville, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.