Provider Demographics
NPI:1134178387
Name:PRINCETON SURGICAL SPECIALISTS PC
Entity type:Organization
Organization Name:PRINCETON SURGICAL SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:CASDEN
Authorized Official - Last Name:HEWLETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-776-8600
Mailing Address - Street 1:833 PRINCETON AVE SW
Mailing Address - Street 2:STE 200F
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35211
Mailing Address - Country:US
Mailing Address - Phone:205-776-8600
Mailing Address - Fax:205-776-8603
Practice Address - Street 1:833 PRINCETON AVE SW
Practice Address - Street 2:STE 200F
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211
Practice Address - Country:US
Practice Address - Phone:205-776-8600
Practice Address - Fax:205-776-8603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-07
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00016867174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALK887Medicare ID - Type UnspecifiedGROUP NUMBER