Provider Demographics
NPI:1578743449
Name:SELMA SURGICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:SELMA SURGICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:INDOVINA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:334-872-0111
Mailing Address - Street 1:200 VAUGHAN MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36701-6508
Mailing Address - Country:US
Mailing Address - Phone:334-872-0111
Mailing Address - Fax:334-872-0136
Practice Address - Street 1:200 VAUGHAN MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701-6508
Practice Address - Country:US
Practice Address - Phone:334-872-0111
Practice Address - Fax:334-872-0136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD28281174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty