Provider Demographics
NPI:1295893956
Name:MONTGOMERY SURGICAL ASSOCIATES
Entity type:Organization
Organization Name:MONTGOMERY SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:H
Authorized Official - Last Name:SHARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-281-9000
Mailing Address - Street 1:2055 E SOUTH BLVD
Mailing Address - Street 2:SUITE 603
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-2001
Mailing Address - Country:US
Mailing Address - Phone:334-281-9000
Mailing Address - Fax:334-281-8262
Practice Address - Street 1:2055 E SOUTH BLVD
Practice Address - Street 2:SUITE 603
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-2001
Practice Address - Country:US
Practice Address - Phone:334-281-9000
Practice Address - Fax:334-281-8262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1215011846OtherHARRIS NPI
ALC70810Medicare UPIN
AL1215011846OtherHARRIS NPI
AL1720161391Medicare UPIN
ALF28626Medicare UPIN
AL1952484560Medicare UPIN
ALHARRISMedicare UPIN