1962513788 NPI number — SURGERY CENTER OF DECATUR LP

Table of content: (NPI 1962513788)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962513788 NPI number — SURGERY CENTER OF DECATUR LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SURGERY CENTER OF DECATUR LP
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:
1962513788
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1164
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DECATUR
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35602-1164
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-560-2890
Provider Business Mailing Address Fax Number:
256-560-2891

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1122 14TH AVENUE SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DECATUR
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35601-3361
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-560-2890
Provider Business Practice Location Address Fax Number:
256-560-2891
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LATHRAM
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
256-560-2890

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  12143 , 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: ABC0073C , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com