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General NPI Number Information
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NPI Number | 1356325138
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN SPINE SPECIALISTS INC
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Dates
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Enumeration Date | 12/05/2005
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Last Update Date | 07/27/2009
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Provider Practice Location Address
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Address Line | 1781 COMMONS NORTH LOOP
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City | TUSCALOOSA
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State | AL
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Zip | 35406-3577
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Country | US
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Telephone | 205-750-0447
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Fax | 205-750-0276
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Provider Business Mailing Address
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Address Line | 1781 COMMONS NORTH LOOP
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City | TUSCALOOSA
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State | AL
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Zip | 35406-3577
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Country | US
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Telephone | 205-750-0447
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Fax | 205-750-0276
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Authorized Official
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Title or Position | PRESIDENT
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Name | TIMOTHY DAVID BASSETT
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Credential | MD
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Telephone | 205-750-0447
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | 00018074
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License Number State | AL
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