MEDICARE: MEDPLEX OUTPATIENT SURGERY CENTER LTD

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	261QA1903X	Ambulatory Surgical Clinic/Center	U5901	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750499950
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDPLEX OUTPATIENT SURGERY CENTER LTD

Provider Business Mailing Address
First Line	:	4511 SOUTHLAKE PKWY
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35244-3238
Country	:	US
Telephone Number	:	205-985-4398
Fax Number	:	205-444-1786

Provider Business Practice Location Address
First Line	:	4511 SOUTHLAKE PKWY
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35244-3238
Country	:	US
Telephone Number	:	205-985-4398
Fax Number	:	205-444-1786

Authorized Official
Title or Position	:	OFFICER / AUTHORIZED OFFICIAL
Name	:	KIRSTEN OCONNOR
Credential	:
Telephone Number	:	615-376-7315

Provider Enumeration Date	:	08/28/2006
Last Update Date	:	10/11/2024

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