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General NPI Number Information
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NPI Number | 1043367196
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Entity Type | Organization
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Legal Business Name | SURGICAL SPECIALISTS GROUP, LLC
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 08/18/2009
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Provider Practice Location Address
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Address Line | 1323 SUMMIT DRIVE
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City | JASPER
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State | AL
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Zip | 35501-0114
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Country | US
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Telephone | 205-221-1324
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Fax | 205-221-1325
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Provider Business Mailing Address
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Address Line | 1323 SUMMIT DRIVE
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City | JASPER
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State | AL
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Zip | 35501-0114
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Country | US
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Telephone | 205-221-1324
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Fax | 205-221-1325
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. GARY ELLIS
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Credential |
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Telephone | 205-221-1324
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State | AL
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