Provider Demographics
NPI:1982660536
Name:SURGICAL ASSOCIATES OF SOUTH ALABAMA, PC
Entity Type:Organization
Organization Name:SURGICAL ASSOCIATES OF SOUTH ALABAMA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:F
Authorized Official - Last Name:BONDURANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-867-8001
Mailing Address - Street 1:PO BOX 384
Mailing Address - Street 2:
Mailing Address - City:BREWTON
Mailing Address - State:AL
Mailing Address - Zip Code:36427-0384
Mailing Address - Country:US
Mailing Address - Phone:251-867-8007
Mailing Address - Fax:251-867-9643
Practice Address - Street 1:103 ELLIOTT ST
Practice Address - Street 2:
Practice Address - City:BREWTON
Practice Address - State:AL
Practice Address - Zip Code:36426-1336
Practice Address - Country:US
Practice Address - Phone:251-867-8001
Practice Address - Fax:251-867-9643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-23
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty