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General NPI Number Information
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NPI Number | 1639454580
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Entity Type | Organization
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Legal Business Name | NURSE ANESTHESIA OF ALABAMA LLC
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Dates
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Enumeration Date | 10/11/2011
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Last Update Date | 10/11/2011
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Provider Practice Location Address
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Address Line | 1515 6TH AVE S
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City | BIRMINGHAM
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State | AL
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Zip | 35233-1601
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Country | US
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Telephone | 205-930-3612
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 222
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City | LANDISVILLE
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State | PA
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Zip | 17538-0222
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Country | US
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Telephone | 205-930-3612
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | ALAN DALE HILLIARD
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Credential |
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Telephone | 336-884-1830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 367H00000X
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Taxonomy Name | Anesthesiologist Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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