Provider Demographics
NPI:1346349164
Name:SOUTHERN ALABAMA SURGERY CENTER LLC
Entity Type:Organization
Organization Name:SOUTHERN ALABAMA SURGERY CENTER LLC
Other - Org Name:SURGERY CENTER SOUTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARRON
Authorized Official - Middle Name:ALANE
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-793-3411
Mailing Address - Street 1:2800 ROSS CLARK CIRCLE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301
Mailing Address - Country:US
Mailing Address - Phone:334-793-3411
Mailing Address - Fax:334-712-0227
Practice Address - Street 1:2800 ROSS CLARK CIR
Practice Address - Street 2:SUITE 3
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-2040
Practice Address - Country:US
Practice Address - Phone:334-793-3411
Practice Address - Fax:334-712-0227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207L00000X, 261Q00000X, 261QA1903X, 367500000X
AL12124261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA03119876AMedicaid
AL128616Medicaid
GA000902316AMedicaid
AL010306OtherBLUE CROSS BLUE SHIELD
FL062936700Medicaid
ALASC0060CMedicaid
AL000057289Medicare UPIN