NPIMap

Organization Active NPI

Marshall Medical Center South

  • Certified Registered Nurse Anesthetist
  • Boaz, AL
National Provider Identifier
1861663874
Registry record updated Aug 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
MARSHALL MEDICAL CENTER SOUTH
Practice address
2505 US Hwy 431N
Boaz, AL 35957-0758
Phone
(256) 593-8310
NPI assigned
Mar 18, 2008
Organization subpart
Yes
Parent organization
MARSHALL MEDICAL CENTER SOUTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 17, 2018

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

Authorized official

Name
Gary R Gore
Title
Ceo
Phone
(256) 593-7266

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse AnesthetistGroup: 193400000X SINGLE SPECIALTY GROUP 367500000X Primary

Addresses

Primary practice location

2505 US Hwy 431N
Boaz, AL 35957-0758

Mailing address

PO Box 758
Boaz, AL 35957-0758
Phone (256) 593-8310

National Provider Directory

National Provider Directory
Tax ID family
James a Clement Jr MMC4 organizations share this tax ID, including this one
Part of
James a Clement Jr MMC

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1205798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534464000000",
    "number": "1861663874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 758",
            "city": "BOAZ",
            "state": "AL",
            "postal_code": "359570758",
            "telephone_number": "256-593-8310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2505 US HWY 431N",
            "city": "BOAZ",
            "state": "AL",
            "postal_code": "359570758",
            "telephone_number": "256-593-8310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARSHALL MEDICAL CENTER SOUTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MARSHALL MEDICAL CENTER SOUTH",
        "enumeration_date": "2008-03-18",
        "last_updated": "2018-08-17",
        "status": "A",
        "authorized_official_last_name": "GORE",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "256-593-7266"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Aug 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.