Provider Demographics
NPI:1336721992
Name:HUNTSVILLE SURGERY CENTER LLC
Entity Type:Organization
Organization Name:HUNTSVILLE SURGERY CENTER LLC
Other - Org Name:LASER EYE SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NICKEL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:256-585-0495
Mailing Address - Street 1:2308 MARKET PL SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5250
Mailing Address - Country:US
Mailing Address - Phone:256-863-3100
Mailing Address - Fax:
Practice Address - Street 1:2308 MARKET PL SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5250
Practice Address - Country:US
Practice Address - Phone:256-863-3100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-23
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Single Specialty