Healthcare Provider Details

I. General information

NPI: 1841655172
Provider Name (Legal Business Name): MONTGOMERY SURGERY SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2015
Last Update Date: 12/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 TAYLOR RD SUITE 202
MONTGOMERY AL
36117-3563
US

IV. Provider business mailing address

470 TAYLOR RD SUITE 202
MONTGOMERY AL
36117-3563
US

V. Phone/Fax

Practice location:
  • Phone: 334-244-6773
  • Fax: 334-244-4234
Mailing address:
  • Phone: 334-244-6773
  • Fax: 334-244-4234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number33601
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number32228
License Number StateAL

VIII. Authorized Official

Name: PEGGY MARIE HUBBARD
Title or Position: PRACTICE MANAGER
Credential:
Phone: 334-244-6773