=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932236692
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DECATUR ANESTHESIOLOGY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1515 6TH AVE S
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35233-1601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-930-3612
-----------------------------------------------------
Fax | 205-930-3322
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 991 LAKE CREST PKWY
-----------------------------------------------------
City | HOOVER
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35226-5008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-283-6665
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MARK A. MURPHY
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 205-930-3612
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | 21022
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------