Provider Demographics
NPI:1003815242
Name:DOTHAN SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:DOTHAN SURGERY CENTER, LLC
Other - Org Name:DOTHAN SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:DAVIS
Authorized Official - Last Name:HARRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:334-793-3442
Mailing Address - Street 1:1450 ROSS CLARK CIR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-4736
Mailing Address - Country:US
Mailing Address - Phone:334-793-3442
Mailing Address - Fax:334-793-3318
Practice Address - Street 1:1450 ROSS CLARK CIR
Practice Address - Street 2:SUITE 4
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-4736
Practice Address - Country:US
Practice Address - Phone:334-793-3442
Practice Address - Fax:334-793-3318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10431261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALASC0066CMedicaid