Provider Demographics
NPI:1386684801
Name:GENERAL SURGERY ASSOCIATES
Entity Type:Organization
Organization Name:GENERAL SURGERY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:S
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-880-4510
Mailing Address - Street 1:4704 WHITESBURG DR SE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-1631
Mailing Address - Country:US
Mailing Address - Phone:256-880-4510
Mailing Address - Fax:256-880-4512
Practice Address - Street 1:4704 WHITESBURG DR SE
Practice Address - Street 2:SUITE 200
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-1631
Practice Address - Country:US
Practice Address - Phone:256-880-4510
Practice Address - Fax:256-880-4512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529502500Medicaid
ALCC7854OtherRAILROAD MEDICARE
ALH120Medicare PIN