Basic Information
| Provider Information | |||||||||
| NPI: | 1831448372 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HUNTSVILLE HOSPITAL SURGICAL ASSOCIATES OF MADISON | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2705 | ||||||||
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| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358042705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2568016036 | ||||||||
| FaxNumber: | 2568016218 | ||||||||
| Practice Location | |||||||||
| Address1: | 1041 BALCH RD STE 350 | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | AL | ||||||||
| PostalCode: | 357588822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2562655951 | ||||||||
| FaxNumber: | 2562655952 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2012 | ||||||||
| LastUpdateDate: | 02/25/2020 | ||||||||
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| AuthorizedOfficialLastName: | POWERS | ||||||||
| AuthorizedOfficialFirstName: | KELLI | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 2562658818 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 31838 | AL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.