NPIMap

Organization Active NPI

Marshall Medical Center South

Doing business as South Emergency Physicians

  • Emergency Medicine Physician
  • Boaz, AL
National Provider Identifier
1760765028
Registry record updated Dec 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
MARSHALL MEDICAL CENTER SOUTH
Doing business as
South Emergency Physicians
Practice address
2505 US Highway 431
Boaz, AL 35957
Phone
(256) 593-8310
NPI assigned
Sep 23, 2011
Last updated
Dec 3, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2024

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

Authorized official

Name
Chris Rush
Title
President
Phone
(256) 894-6745

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X Primary

Addresses

Primary practice location

2505 US Highway 431
Boaz, AL 35957

Mailing address

PO Box 11407
Dept 2079
Birmingham, AL 35246-2079
Phone (866) 313-5260

Other identifiers 2

IdentifierTypeStateIssuer
558200290MedicaidAL
135643MedicaidAL

Other names 1

  • South Emergency Physicians Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111108000249 AL Part B Supplier - Clinic/Group Practice 9234302290 Receives reassigned benefits from 34 practitioners
Practice locations: Boaz, AL

National Provider Directory

National Provider Directory

Member of 1

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

Practitioners & affiliated clinicians

Practitioners 37

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.

View all 37

NPI Registry JSON

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

{
    "created_epoch": "1316736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733184000000",
    "number": "1760765028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11407",
            "address_2": "DEPT 2079",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352462079",
            "telephone_number": "866-313-5260",
            "fax_number": "205-313-5245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2505 US HIGHWAY 431",
            "city": "BOAZ",
            "state": "AL",
            "postal_code": "35957",
            "telephone_number": "256-593-8310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARSHALL MEDICAL CENTER SOUTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-23",
        "last_updated": "2024-12-03",
        "certification_date": "2024-12-03",
        "status": "A",
        "authorized_official_last_name": "RUSH",
        "authorized_official_first_name": "CHRIS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "256-894-6745"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "558200290",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "135643",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Emergency Physicians",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Boaz, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2024; 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.