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General NPI Number Information
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NPI Number | 1578743449
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Entity Type | Organization
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Legal Business Name | SELMA SURGICAL ASSOCIATES, LLC
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Dates
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Enumeration Date | 11/08/2007
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Last Update Date | 05/30/2008
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Provider Practice Location Address
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Address Line | 200 VAUGHAN MEMORIAL DR
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City | SELMA
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State | AL
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Zip | 36701-6508
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Country | US
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Telephone | 334-872-0111
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Fax | 334-872-0136
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Provider Business Mailing Address
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Address Line | 200 VAUGHAN MEMORIAL DR
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City | SELMA
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State | AL
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Zip | 36701-6508
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Country | US
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Telephone | 334-872-0111
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Fax | 334-872-0136
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN A. INDOVINA JR.
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Credential | MD
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Telephone | 334-872-0111
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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 | MD28281
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License Number State | AL
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