=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053661108
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RESEARCH SURGICAL CENTER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2012
-----------------------------------------------------
Last Update Date | 05/14/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2446 RESEARCH PARKWAY SUITE 100
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80920
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-623-1050
-----------------------------------------------------
Fax | 719-623-1052
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 CHASE CORPORATE DR SUITE 200
-----------------------------------------------------
City | HOOVER
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35244-1026
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-824-6250
-----------------------------------------------------
Fax | 205-824-6251
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT AND CEO
-----------------------------------------------------
Name | MR. LARRY D TAYLOR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 205-824-6250
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------