Healthcare Provider Details

I. General information

NPI: 1225579485
Provider Name (Legal Business Name): SUNRISE SKIN CANCER SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2017
Last Update Date: 03/18/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 MIDTOWN PARK E STE A
MOBILE AL
36606-4140
US

IV. Provider business mailing address

70 MIDTOWN PARK E
MOBILE AL
36606-4140
US

V. Phone/Fax

Practice location:
  • Phone: 251-544-6407
  • Fax: 251-544-6411
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateAL

VIII. Authorized Official

Name: SARAH WIERSZALOWSKI
Title or Position: ADMINISTRATOR
Credential: MSN, RN
Phone: 251-544-6407