Provider Demographics
NPI:1790879559
Name:SURGICAL ASSOCIATES OF THE SHOALS, PC
Entity Type:Organization
Organization Name:SURGICAL ASSOCIATES OF THE SHOALS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:CONNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-386-1125
Mailing Address - Street 1:1120 S JACKSON HWY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SHEFFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35660
Mailing Address - Country:US
Mailing Address - Phone:256-386-1125
Mailing Address - Fax:888-745-7084
Practice Address - Street 1:1120 S JACKSON HWY
Practice Address - Street 2:SUITE 105
Practice Address - City:SHEFFIELD
Practice Address - State:AL
Practice Address - Zip Code:35660
Practice Address - Country:US
Practice Address - Phone:256-386-1125
Practice Address - Fax:888-745-7084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529001490Medicaid
AL125383Medicaid
AL51113246OtherBLUE CROSS
AL125383Medicaid
AL125383Medicaid