MEDICARE: EASTERN SURGICAL ASSOCIATES, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1265589972
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASTERN SURGICAL ASSOCIATES, P.C.

Provider Business Mailing Address
First Line	:	52 MEDICAL PARK EAST DRIVE
Second Line	:	SUITE 308
City	:	BIRMINGHAM
State	:	AL
Zip	:	35235-3433
Country	:	US
Telephone Number	:	205-838-3025
Fax Number	:	205-838-3897

Provider Business Practice Location Address
First Line	:	52 MEDICAL PARK EAST DRIVE
Second Line	:	SUITE 308
City	:	BIRMINGHAM
State	:	AL
Zip	:	35235-3433
Country	:	US
Telephone Number	:	208-838-3025
Fax Number	:	205-838-3897

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	ROBIN M SMITH
Credential	:
Telephone Number	:	205-838-3025

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	02/18/2022

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