Healthcare Provider Details

I. General information

NPI: 1982660536
Provider Name (Legal Business Name): SURGICAL ASSOCIATES OF SOUTH ALABAMA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2006
Last Update Date: 02/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 ELLIOTT ST
BREWTON AL
36426-1336
US

IV. Provider business mailing address

PO BOX 384
BREWTON AL
36427-0384
US

V. Phone/Fax

Practice location:
  • Phone: 251-867-8001
  • Fax: 251-867-9643
Mailing address:
  • Phone: 251-867-8007
  • Fax: 251-867-9643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. IRENE F BONDURANT
Title or Position: OFFICE MANAGER
Credential:
Phone: 251-867-8001