1376358481 NPI number — SOUTHEAST ALABAMA SURGICAL LLC

Table of content: (NPI 1750482915)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376358481 NPI number — SOUTHEAST ALABAMA SURGICAL LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHEAST ALABAMA SURGICAL 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:
1376358481
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1114 GA HIGHWAY 96 STE C1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KATHLEEN
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31047-4102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
478-330-5747
Provider Business Mailing Address Fax Number:
478-310-3105

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
107 OBRANNAN PARK DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOTHAN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-330-5747
Provider Business Practice Location Address Fax Number:
478-310-3105
Provider Enumeration Date:
02/07/2025

Additional Information

Authorized Official

Authorized Official Last Name:
VOSS
Authorized Official First Name:
ASHA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
334-804-3536

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com