Provider Demographics
NPI:1851681183
Name:SURGERY CLINIC, LLC
Entity Type:Organization
Organization Name:SURGERY CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:KEENER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-547-6331
Mailing Address - Street 1:419 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-5101
Mailing Address - Country:US
Mailing Address - Phone:256-547-6331
Mailing Address - Fax:256-547-1711
Practice Address - Street 1:395 NORTHWOOD DR
Practice Address - Street 2:
Practice Address - City:CENTRE
Practice Address - State:AL
Practice Address - Zip Code:35960-1045
Practice Address - Country:US
Practice Address - Phone:256-547-6331
Practice Address - Fax:256-547-1711
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE SURGERY CLINIC, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-07
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL128498Medicaid
ALD235Medicare PIN
AL128498Medicaid
ALC70288Medicare UPIN
ALG07898Medicare UPIN
ALE89699Medicare UPIN