Healthcare Provider Details

I. General information

NPI: 1962057497
Provider Name (Legal Business Name): CLEARWAY SURGERY CENTER OF MOBILE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2019
Last Update Date: 08/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 DOWNTOWNER BLVD STE A
MOBILE AL
36609-5403
US

IV. Provider business mailing address

PO BOX 11637
PENSACOLA FL
32524-1637
US

V. Phone/Fax

Practice location:
  • Phone: 850-484-4080
  • Fax: 850-484-8801
Mailing address:
  • Phone: 850-484-4080
  • Fax: 850-484-8801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JESSICA SCHLEMBACH
Title or Position: CHIEF COMPLIANCE OFFICER
Credential:
Phone: 850-439-5425