Provider Demographics
NPI:1568649754
Name:BRENDA L CASSELBERRY
Entity Type:Organization
Organization Name:BRENDA L CASSELBERRY
Other - Org Name:AUBURN OPELIKA AMBULATORY-SURG CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CASSELBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:334-705-0544
Mailing Address - Street 1:PO BOX 1268
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36831-1268
Mailing Address - Country:US
Mailing Address - Phone:334-705-0544
Mailing Address - Fax:334-705-0548
Practice Address - Street 1:2121 EXECUTIVE PARK DR
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-6041
Practice Address - Country:US
Practice Address - Phone:334-705-0544
Practice Address - Fax:334-705-0531
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRENDA L CASSELBERRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-30
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL132261QA1903X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1750484358OtherNPI - INDIVIDUAL
AL480013769OtherMEDICARE R/R
AL529912550Medicaid
AL5043300001OtherPALMETTO - GBA DMERC OPER
AL51540360OtherBCBS - TUSKEGEE
AL51540725OtherBCBS - OPELIKA
AL529912550Medicaid
AL5043300001OtherPALMETTO - GBA DMERC OPER