Provider Demographics
NPI:1790955920
Name:AVALON SURGICAL,P.C.
Entity Type:Organization
Organization Name:AVALON SURGICAL,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:PARKS
Authorized Official - Last Name:MCKINLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:256-381-0030
Mailing Address - Street 1:PO BOX 298
Mailing Address - Street 2:
Mailing Address - City:SHEFFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35660-0298
Mailing Address - Country:US
Mailing Address - Phone:256-381-0030
Mailing Address - Fax:256-383-0764
Practice Address - Street 1:1120 S JACKSON HWY STE 307
Practice Address - Street 2:
Practice Address - City:SHEFFIELD
Practice Address - State:AL
Practice Address - Zip Code:35660-5773
Practice Address - Country:US
Practice Address - Phone:256-381-0030
Practice Address - Fax:256-383-0764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5762208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALDD6002OtherMETRAHEALTH/RAILROAD
AL00780OtherFIRSTCOMMUNITY
AL529926920Medicaid
AL10912029OtherCAQH
AL17-00656OtherUNITEDHEALTHCARE
AL10912029OtherCAQH