Provider Demographics
NPI:1821006495
Name:FSG IMMUNIZATIONS, INC.
Entity type:Organization
Organization Name:FSG IMMUNIZATIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:BUSKILL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:334-524-0595
Mailing Address - Street 1:1505 FITZPATRICK AVE
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-4822
Mailing Address - Country:US
Mailing Address - Phone:334-524-0595
Mailing Address - Fax:866-683-9417
Practice Address - Street 1:1505 FITZPATRICK AVE
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-4822
Practice Address - Country:US
Practice Address - Phone:334-524-0595
Practice Address - Fax:866-683-9417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1049058163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051554914WOOMedicare ID - Type Unspecified
ALY14505Medicare UPIN