Provider Demographics
NPI:1932319605
Name:TUESDAY BIGELOW COSMETIC SURGERY CENTER
Entity Type:Organization
Organization Name:TUESDAY BIGELOW COSMETIC SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TUESDAY
Authorized Official - Middle Name:K
Authorized Official - Last Name:BIGELOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-259-5950
Mailing Address - Street 1:1202 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768-2516
Mailing Address - Country:US
Mailing Address - Phone:256-259-5950
Mailing Address - Fax:256-259-5954
Practice Address - Street 1:1202 S BROAD ST
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-2516
Practice Address - Country:US
Practice Address - Phone:256-259-5950
Practice Address - Fax:256-259-5954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL01107174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALE10500Medicare UPIN
AL5102688BIGMedicare ID - Type Unspecified