=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922997477
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COLONNADE SURGICAL PARTNERS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2025
-----------------------------------------------------
Last Update Date | 11/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3980 COLONNADE PKWY STE 100
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35243-2382
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-876-8967
-----------------------------------------------------
Fax | 205-564-0538
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 59449
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35259-9449
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-876-8967
-----------------------------------------------------
Fax | 205-564-0538
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED OFFICIAL
-----------------------------------------------------
Name | DR. JASON SWANNER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 205-317-0009
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QS0132X
-----------------------------------------------------
Taxonomy Name | Ophthalmologic Surgery Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------