Provider Demographics
NPI:1467662031
Name:DEACTUR ANESTHESIOLOGY & ASSOCIATES, LLC
Entity Type:Organization
Organization Name:DEACTUR ANESTHESIOLOGY & ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:P
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-930-3612
Mailing Address - Street 1:P.O. BOX 55962
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35255
Mailing Address - Country:US
Mailing Address - Phone:205-930-3612
Mailing Address - Fax:205-930-3322
Practice Address - Street 1:1515 6TH AVENUE SOUTH
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233
Practice Address - Country:US
Practice Address - Phone:205-930-3612
Practice Address - Fax:205-930-3322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL06008483174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALE67611OtherKEVIN KENNEDY
ALDO6587Medicare UPIN
ALC71434Medicare UPIN