Provider Demographics
NPI:1245992155
Name:ADVANTAGE SURGICAL AND WOUND CARE ALABAMA PC
Entity type:Organization
Organization Name:ADVANTAGE SURGICAL AND WOUND CARE ALABAMA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:URI
Authorized Official - Middle Name:
Authorized Official - Last Name:GEDALIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:877-878-3289
Mailing Address - Street 1:222 N PACIFIC COAST HWY STE 2175
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-5639
Mailing Address - Country:US
Mailing Address - Phone:877-878-3289
Mailing Address - Fax:877-817-3227
Practice Address - Street 1:65 CHARLTON PL
Practice Address - Street 2:
Practice Address - City:DEATSVILLE
Practice Address - State:AL
Practice Address - Zip Code:36022-2697
Practice Address - Country:US
Practice Address - Phone:877-878-3289
Practice Address - Fax:877-817-3227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty