Provider Demographics
NPI:1760425482
Name:SURGICAL ASSOCIATES OF MARSHALL COUNTY
Entity Type:Organization
Organization Name:SURGICAL ASSOCIATES OF MARSHALL COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:AMYE
Authorized Official - Middle Name:W
Authorized Official - Last Name:GROVES
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:256-840-5547
Mailing Address - Street 1:133 WALL ST.
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35951
Mailing Address - Country:US
Mailing Address - Phone:256-840-5547
Mailing Address - Fax:256-840-5547
Practice Address - Street 1:133 WALL ST.
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35951
Practice Address - Country:US
Practice Address - Phone:256-840-5547
Practice Address - Fax:256-840-5547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALK178Medicare ID - Type UnspecifiedMEDICARE GROUP #