Basic Information
| Provider Information | |||||||||
| NPI: | 1386194454 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PATRIOT PERIOPERATIVE PARTNERS, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3104 BLUE LAKE DR | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | VESTAVIA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352432345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3342478769 | ||||||||
| FaxNumber: | 3343774417 | ||||||||
| Practice Location | |||||||||
| Address1: | 2868 ACTON RD | ||||||||
| Address2: | |||||||||
| City: | VESTAVIA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352432502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3342478769 | ||||||||
| FaxNumber: | 3343774417 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2016 | ||||||||
| LastUpdateDate: | 10/12/2016 | ||||||||
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| AuthorizedOfficialLastName: | JACKSON | ||||||||
| AuthorizedOfficialFirstName: | KEITH | ||||||||
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| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 2052138420 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.