1619087319 NPI number — SOUTHEAST ANESTHESIA ASSOCIATES, LLC

Table of content: (NPI 1619087319)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619087319 NPI number — SOUTHEAST ANESTHESIA ASSOCIATES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHEAST ANESTHESIA ASSOCIATES, LLC
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:
Provider Other Organization Name Type Code:
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:
1619087319
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/26/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 660257
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35266-0257
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-979-5882
Provider Business Mailing Address Fax Number:
205-979-1248

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7191 CAHABA VALLEY RD
Provider Second Line Business Practice Location Address:
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:
35242-6402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-408-9787
Provider Business Practice Location Address Fax Number:
205-408-3993
Provider Enumeration Date:
08/30/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
COMBS
Authorized Official First Name:
JASON
Authorized Official Middle Name:
WILLIAM
Authorized Official Title or Position:
CO-OWNER
Authorized Official Telephone Number:
205-213-8420

Provider Taxonomy Codes

  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 529921400 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: DB7661 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".