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General NPI Number Information
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NPI Number | 1205893732
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Entity Type | Organization
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Legal Business Name | SURGERY CLINIC, LLC
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Dates
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Enumeration Date | 04/27/2006
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Last Update Date | 08/17/2011
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Provider Practice Location Address
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Address Line | 419 S 5TH ST
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City | GADSDEN
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State | AL
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Zip | 35901-5101
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Country | US
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Telephone | 256-547-6331
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Fax | 256-547-1711
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Provider Business Mailing Address
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Address Line | 419 S 5TH ST
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City | GADSDEN
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State | AL
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Zip | 35901-5101
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Country | US
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Telephone | 256-547-6331
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Fax | 256-547-1711
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | DIANETTE KEENER
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Credential |
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Telephone | 256-547-6331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State | AL
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