=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568428969
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE SURGEONS' GROUP, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2006
-----------------------------------------------------
Last Update Date | 04/23/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 917 TUSCALOOSA AVE SW
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35211-1618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-780-7150
-----------------------------------------------------
Fax | 205-783-9326
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 917 TUSCALOOSA AVE SW
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35211-1618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-780-7150
-----------------------------------------------------
Fax | 205-783-9326
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JOHN LOUIS MATHEWS
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 205-780-7150
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 8477
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------