Provider Demographics
NPI:1003154238
Name:ANESTHESIA MANAGEMENT GROUP OF NORTH ALABAMA,LLC
Entity Type:Organization
Organization Name:ANESTHESIA MANAGEMENT GROUP OF NORTH ALABAMA,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-996-2640
Mailing Address - Street 1:PO BOX 680045
Mailing Address - Street 2:
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35968-1601
Mailing Address - Country:US
Mailing Address - Phone:256-845-5605
Mailing Address - Fax:866-409-9490
Practice Address - Street 1:938 COUNTY ROAD 239
Practice Address - Street 2:
Practice Address - City:VALLEY HEAD
Practice Address - State:AL
Practice Address - Zip Code:35989-4726
Practice Address - Country:US
Practice Address - Phone:256-845-5605
Practice Address - Fax:866-409-9490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty