Provider Demographics
NPI:1508070293
Name:THE SURGERY CLINIC, LLC
Entity Type:Organization
Organization Name:THE SURGERY CLINIC, LLC
Other - Org Name:OMI OF GADSDEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PATIENT ACCOUNT MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEVIN
Authorized Official - Middle Name:U
Authorized Official - Last Name:COOKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-546-7507
Mailing Address - Street 1:1026 GOODYEAR AVE
Mailing Address - Street 2:SUITE 50
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35903-1102
Mailing Address - Country:US
Mailing Address - Phone:256-546-7507
Mailing Address - Fax:256-492-8345
Practice Address - Street 1:1026 GOODYEAR AVE
Practice Address - Street 2:SUITE 50
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-1102
Practice Address - Country:US
Practice Address - Phone:256-546-7507
Practice Address - Fax:256-492-8345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2471N0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471N0900XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistNuclear Medicine TechnologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALD235Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER