Provider Demographics
NPI:1841342789
Name:SURGERY CENTER JV
Entity type:Organization
Organization Name:SURGERY CENTER JV
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-533-4888
Mailing Address - Street 1:721 MADISON ST SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4408
Mailing Address - Country:US
Mailing Address - Phone:256-533-4888
Mailing Address - Fax:256-532-9510
Practice Address - Street 1:721 MADISON ST SE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4408
Practice Address - Country:US
Practice Address - Phone:256-533-4888
Practice Address - Fax:256-532-9510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL261QA1903X261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL165102800OtherOWCP PROVIDER #
AL8121099OtherAETNA PIN #
ALASC0005CMedicaid
AL010308OtherBCBS PROVIDER #
AL4287002OtherMEDIPLUS ID #
AL51055040OtherBLUE SHIELD PROVIDER #
AL6810002OtherUNITED HEALTH CARE PROV#
AL490000353OtherRAILROAD MEDICARE PROVIDE
AL490000353OtherRAILROAD MEDICARE PROVIDE
AL=========358010000OtherTRICARE PROVIDER #
AL010308OtherBCBS PROVIDER #