Provider Demographics
NPI:1366466781
Name:UAB MEDICAL WEST ASC LLC
Entity Type:Organization
Organization Name:UAB MEDICAL WEST ASC LLC
Other - Org Name:MEDICAL WEST SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:PENNINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-481-7268
Mailing Address - Street 1:995 9TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35022-4527
Mailing Address - Country:US
Mailing Address - Phone:205-481-7268
Mailing Address - Fax:205-481-7595
Practice Address - Street 1:995 9TH AVE SW
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35022-4527
Practice Address - Country:US
Practice Address - Phone:205-481-7268
Practice Address - Fax:205-481-7595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL2004018261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical