Provider Demographics
NPI:1922030113
Name:GADSDEN REGIONAL PRIMARY CARE LLC
Entity Type:Organization
Organization Name:GADSDEN REGIONAL PRIMARY CARE LLC
Other - Org Name:RUIZ NEUROSURGERY CLINIC, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PROVIDER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:T
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7626
Mailing Address - Street 1:7100 COMMERCE WAY
Mailing Address - Street 2:SUITE 180
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-2829
Mailing Address - Country:US
Mailing Address - Phone:615-465-7000
Mailing Address - Fax:
Practice Address - Street 1:300 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 303
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-1157
Practice Address - Country:US
Practice Address - Phone:256-494-3033
Practice Address - Fax:256-494-3036
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GADSDEN REGIONAL PRIMARY CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11698174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051515965OtherBLUE CROSS BLUE SHIELD AL
AL051515965OtherBLUE CROSS BLUE SHIELD AL
ALJ400Medicare PIN