Provider Demographics
NPI:1114367604
Name:VESTAVIA SURGICAL CENTER, LLC
Entity Type:Organization
Organization Name:VESTAVIA SURGICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:KINGSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-823-0151
Mailing Address - Street 1:700 MONTGOMERY HWY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35216-1866
Mailing Address - Country:US
Mailing Address - Phone:205-823-0150
Mailing Address - Fax:205-823-5218
Practice Address - Street 1:700 MONTGOMERY HWY
Practice Address - Street 2:SUITE 210
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35216-1866
Practice Address - Country:US
Practice Address - Phone:205-823-0150
Practice Address - Fax:205-823-5218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-27
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL443871261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical