1386855930 NPI number — ALABAMA SURGICAL SPECIALISTS

Table of content: (NPI 1386855930)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386855930 NPI number — ALABAMA SURGICAL SPECIALISTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALABAMA SURGICAL SPECIALISTS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ORTHOPAEDIC SPORTS MEDICINE CLINIC OF ALABAMA
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386855930
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/10/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 MONTGOMERY HWY
Provider Second Line Business Mailing Address:
SUITE 125
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35216-1842
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-978-4969
Provider Business Mailing Address Fax Number:
205-978-4964

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 MONTGOMERY HWY
Provider Second Line Business Practice Location Address:
SUITE 125 AND SUITE 200
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35216-1842
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-978-4969
Provider Business Practice Location Address Fax Number:
205-978-4964
Provider Enumeration Date:
05/25/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DARDEN
Authorized Official First Name:
LEE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
205-978-4969

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)