Healthcare Provider Details

I. General information

NPI: 1346349164
Provider Name (Legal Business Name): SOUTHERN ALABAMA SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 10/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 ROSS CLARK CIR SUITE 3
DOTHAN AL
36301-2040
US

IV. Provider business mailing address

2800 ROSS CLARK CIRCLE SUITE 3
DOTHAN AL
36301
US

V. Phone/Fax

Practice location:
  • Phone: 334-793-3411
  • Fax: 334-712-0227
Mailing address:
  • Phone: 334-793-3411
  • Fax: 334-712-0227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number12124
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHARRON ALANE BYRD
Title or Position: ADMINISTER
Credential:
Phone: 334-793-3411