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General NPI Number Information
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NPI Number | 1336375930
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Entity Type | Organization
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Legal Business Name | JACKSON SURGERY CENTER, LLC
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Dates
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Enumeration Date | 06/09/2009
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Last Update Date | 02/14/2022
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Provider Practice Location Address
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Address Line | 1725 PARK PL
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City | MONTGOMERY
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State | AL
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Zip | 36106-1138
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Country | US
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Telephone | 334-293-8484
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Fax | 334-293-6880
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Provider Business Mailing Address
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Address Line | 1725 PARK PL
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City | MONTGOMERY
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State | AL
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Zip | 36106-1138
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Country | US
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Telephone | 334-293-8484
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Fax | 334-293-6880
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MISSY SALLAS
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Credential |
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Telephone | 334-293-3920
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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 | PENDING
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License Number State | AL
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