Provider Demographics
NPI:1538117841
Name:SHELBY BAPTIST AMBULATORY SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:SHELBY BAPTIST AMBULATORY SURGERY CENTER, LLC
Other - Org Name:SHELBY AMBULATORY SURGERY AT THE PHYSICIANS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:TRENT
Authorized Official - Last Name:PIVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-620-8400
Mailing Address - Street 1:1010 1ST ST N
Mailing Address - Street 2:
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-8608
Mailing Address - Country:US
Mailing Address - Phone:205-620-8400
Mailing Address - Fax:205-620-8423
Practice Address - Street 1:1010 1ST ST N
Practice Address - Street 2:
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-8608
Practice Address - Country:US
Practice Address - Phone:205-620-8400
Practice Address - Fax:205-620-8423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical