Healthcare Provider Details

I. General information

NPI: 1215926993
Provider Name (Legal Business Name): NORTH RIVER SURGICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 04/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 RICE MINE RD NE
TUSCALOOSA AL
35406-2403
US

IV. Provider business mailing address

301 RICE MINE RD NE
TUSCALOOSA AL
35406-2403
US

V. Phone/Fax

Practice location:
  • Phone: 205-750-0022
  • Fax: 205-750-2373
Mailing address:
  • Phone: 205-750-0022
  • Fax: 205-750-2373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number10452
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberU6303
License Number StateAL

VIII. Authorized Official

Name: CLARENCE D HOWE
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 205-750-0022