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RRC010005-00 MARSHALL MEDICAL CENTER SOUTH (Terminated)
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Main Details
Name
MARSHALL MEDICAL CENTER SOUTH
Subdivision Name
Type
Rural Referral Center
Rural
Yes
340B ID
RRC010005-00
Medicare Provider Number
010005
Additional Details
Current Program Status
Terminated
Registration Date
5/9/2011
Participating Start Date
7/1/2011
Participating Approval Date
5/10/2011
Last Recertification Date
8/5/2015
Termination Date
Termination Reason
4/1/2016
Change of covered entity type
Contacts
Authorizing Official
Marshall Medical Centers
GARY R. GORE, CEO
(256) 894-6611
Primary Contact
Marshall Medical Center South
KATHY B. NELSON, CFO
(256) 894-6701
Addresses
Street Address
2505 US HIGHWAY 431 NORTH
BOAZ, AL 35957
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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