Basic Information
| Provider Information | |||||||||
| NPI: | 1700843869 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SYLACAUGA ANESTHESIA PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 235022 | ||||||||
| Address2: | |||||||||
| City: | MONTGOMERY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 361235022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3343862051 | ||||||||
| FaxNumber: | 3343966929 | ||||||||
| Practice Location | |||||||||
| Address1: | 315 WEST HICKORY ST | ||||||||
| Address2: | |||||||||
| City: | SYLACAUGA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2562495000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | GORDON | ||||||||
| AuthorizedOfficialFirstName: | GENE | ||||||||
| AuthorizedOfficialMiddleName: | N | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2054274976 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 01924 | AL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.