Provider Demographics
NPI:1740233394
Name:SOUTHERN PERIOPERATIVE SERVICES P C
Entity type:Organization
Organization Name:SOUTHERN PERIOPERATIVE SERVICES P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:E
Authorized Official - Last Name:NICHOLSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-862-4747
Mailing Address - Street 1:5336 STADIUM TRACE PKWY STE 104
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-4581
Mailing Address - Country:US
Mailing Address - Phone:205-795-3411
Mailing Address - Fax:855-647-9621
Practice Address - Street 1:1400 MCFARLAND BLVD N
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2209
Practice Address - Country:US
Practice Address - Phone:205-345-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALI054Medicare ID - Type UnspecifiedMEDICARE GROUP