Provider Demographics
NPI:1932236692
Name:DECATUR ANESTHESIOLOGY
Entity Type:Organization
Organization Name:DECATUR ANESTHESIOLOGY
Other - Org Name:JEFFERSON CLINIC,P C
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-930-3612
Mailing Address - Street 1:991 LAKE CREST PKWY
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35226-5008
Mailing Address - Country:US
Mailing Address - Phone:205-283-6665
Mailing Address - Fax:
Practice Address - Street 1:1515 6TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1601
Practice Address - Country:US
Practice Address - Phone:205-930-3612
Practice Address - Fax:205-930-3322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21022207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALPIN 00104060OtherGROUP CK 7878
AL00038287Medicaid
ALG 44433Medicare UPIN