Healthcare Provider Details

I. General information

NPI: 1093351223
Provider Name (Legal Business Name): BERRYHILL SURGICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2019
Last Update Date: 04/20/2020
Certification Date: 04/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 BERRYHILL RD
MONTGOMERY AL
36117-3599
US

IV. Provider business mailing address

2080 BERRYHILL RD
MONTGOMERY AL
36117-3599
US

V. Phone/Fax

Practice location:
  • Phone: 334-387-2020
  • Fax: 334-387-2019
Mailing address:
  • Phone: 334-387-2020
  • Fax: 334-387-2019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WESTON DANIEL
Title or Position: CEO
Credential:
Phone: 334-387-2020