Healthcare Provider Details

I. General information

NPI: 1083348023
Provider Name (Legal Business Name): SCA HEALTH ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

569 BROOKWOOD VLG STE 901
BIRMINGHAM AL
35209-4513
US

IV. Provider business mailing address

569 BROOKWOOD VLG STE 901
BIRMINGHAM AL
35209-4513
US

V. Phone/Fax

Practice location:
  • Phone: 951-200-9995
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRIS MAURICE
Title or Position: VICE PRESIDENT, RCS
Credential:
Phone: 951-200-9995