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General NPI Number Information
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NPI Number | 1265589972
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Entity Type | Organization
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Legal Business Name | EASTERN SURGICAL ASSOCIATES, P.C.
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 02/18/2022
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Provider Practice Location Address
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Address Line | 52 MEDICAL PARK EAST DRIVE SUITE 308
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City | BIRMINGHAM
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State | AL
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Zip | 35235-3433
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Country | US
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Telephone | 208-838-3025
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Fax | 205-838-3897
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Provider Business Mailing Address
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Address Line | 52 MEDICAL PARK EAST DRIVE SUITE 308
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City | BIRMINGHAM
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State | AL
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Zip | 35235-3433
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Country | US
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Telephone | 205-838-3025
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Fax | 205-838-3897
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | ROBIN M SMITH
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Credential |
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Telephone | 205-838-3025
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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