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RRC010005-12 MARSHALL MEDICAL CENTER SOUTH (Terminated)
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Main Details
Name
MARSHALL MEDICAL CENTER SOUTH
Subdivision Name
Marshall Professional Center - Marshall Pain Clinic
Type
Rural Referral Center
Rural
Yes
340B ID
RRC010005-12
Medicare Provider Number
010005
Outpatient Facility Provider Number
010005
Additional Details
Current Program Status
Terminated
Registration Date
7/2/2014
Participating Start Date
10/1/2014
Participating Approval Date
9/4/2014
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
11491 US Hwy 431
Albertville, AL 35950-0136
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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