1659472983 NPI number — SURGICAL ASSOCIATES OF GADSDEN PC

Table of content: (NPI 1659472983)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659472983 NPI number — SURGICAL ASSOCIATES OF GADSDEN PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SURGICAL ASSOCIATES OF GADSDEN PC
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:
1659472983
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/13/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 GOODYEAR AVE
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
GADSDEN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35903-1108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-492-0020
Provider Business Mailing Address Fax Number:
256-492-0029

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 GOODYEAR AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
GADSDEN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35903-1108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-492-0020
Provider Business Practice Location Address Fax Number:
256-492-0029
Provider Enumeration Date:
09/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ECHEVERRI
Authorized Official First Name:
ALBERTO
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/GEN SURGEON MEDICAL DOCTOR
Authorized Official Telephone Number:
256-492-0020

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  8001055 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 051076949 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 1609837152 . This is a "NPI" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 1659472983 . This is a "NPI GROUP" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 1891976833 . This is a "NPI" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: C12823 . This is a "RAILROAD MEDICARE GROUP" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: P00401656 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 529203130 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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