Provider Demographics
NPI:1487011086
Name:TOMBIGBEE HEALTHCARE AUTHORITY
Entity Type:Organization
Organization Name:TOMBIGBEE HEALTHCARE AUTHORITY
Other - Org Name:TWO RIVERS SURGICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:GANDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-287-2423
Mailing Address - Street 1:105 US HIGHWAY 80 E
Mailing Address - Street 2:STE 215
Mailing Address - City:DEMOPOLIS
Mailing Address - State:AL
Mailing Address - Zip Code:36732-3605
Mailing Address - Country:US
Mailing Address - Phone:334-287-2840
Mailing Address - Fax:334-287-2846
Practice Address - Street 1:105 US HIGHWAY 80 E
Practice Address - Street 2:STE 215
Practice Address - City:DEMOPOLIS
Practice Address - State:AL
Practice Address - Zip Code:36732-3605
Practice Address - Country:US
Practice Address - Phone:334-287-2840
Practice Address - Fax:334-287-2846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-27
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty