MEDICARE: ADVANCED SURGICAL CARE PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1871523597
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED SURGICAL CARE PC

Provider Business Mailing Address
First Line	:	1120 S JACKSON HWY STE 203
Second Line	:
City	:	SHEFFIELD
State	:	AL
Zip	:	35660-5770
Country	:	US
Telephone Number	:	256-314-6947
Fax Number	:	256-314-6902

Provider Business Practice Location Address
First Line	:	1120 S JACKSON HWY STE 203
Second Line	:
City	:	SHEFFIELD
State	:	AL
Zip	:	35660-5770
Country	:	US
Telephone Number	:	256-314-6947
Fax Number	:	256-314-6902

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	EXIE WALLACE
Credential	:
Telephone Number	:	256-314-6947

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	08/11/2019

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