Healthcare Provider Details

I. General information

NPI: 1902176274
Provider Name (Legal Business Name): MARSHALL SCOTT SAVAGE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2012
Last Update Date: 01/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 19TH ST S
BIRMINGHAM AL
35249-1900
US

IV. Provider business mailing address

309 CREEKSIDE LN
PELHAM AL
35124-3982
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-3411
  • Fax:
Mailing address:
  • Phone: 205-563-6324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-116285
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: