Provider Demographics
NPI:1598839516
Name:JEFFERSON SHELBY SURGICAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:JEFFERSON SHELBY SURGICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARTON
Authorized Official - Middle Name:S
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-663-1180
Mailing Address - Street 1:PO BOX 927
Mailing Address - Street 2:
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-2052
Mailing Address - Country:US
Mailing Address - Phone:205-663-1180
Mailing Address - Fax:205-663-1221
Practice Address - Street 1:636 2ND ST NE
Practice Address - Street 2:SUITE A
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-8817
Practice Address - Country:US
Practice Address - Phone:205-663-1180
Practice Address - Fax:205-663-1221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
J343OtherMEDICARE PTAN