Provider Demographics
NPI:1639130537
Name:AMBULATORY ANESTHESIA ASSOCIATES OF MONTGOMERY, PC
Entity Type:Organization
Organization Name:AMBULATORY ANESTHESIA ASSOCIATES OF MONTGOMERY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:P
Authorized Official - Last Name:WARE
Authorized Official - Suffix:III
Authorized Official - Credentials:DO
Authorized Official - Phone:205-914-9822
Mailing Address - Street 1:2151 OLD ROCKY RIDGE RD STE 106
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA HILLS
Mailing Address - State:AL
Mailing Address - Zip Code:35216-7251
Mailing Address - Country:US
Mailing Address - Phone:205-989-1091
Mailing Address - Fax:205-989-1087
Practice Address - Street 1:470 TAYLOR RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-3563
Practice Address - Country:US
Practice Address - Phone:334-284-9600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-30
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALF750OtherBCBS CLINIC ID
AL529901210Medicaid
ALH270Medicare ID - Type UnspecifiedMEDICARE GROUP #