Basic Information
| Provider Information | |||||||||
| NPI: | 1346352002 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COOSA VALLEY SURGICAL ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 209 W SPRING ST STE 300 | ||||||||
| Address2: | |||||||||
| City: | SYLACAUGA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 351502976 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2562458100 | ||||||||
| FaxNumber: | 2059860081 | ||||||||
| Practice Location | |||||||||
| Address1: | 209 W SPRING ST STE 300 | ||||||||
| Address2: | |||||||||
| City: | SYLACAUGA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 351502976 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2562458100 | ||||||||
| FaxNumber: | 2059860081 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | CROOK | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | PROVIDER/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2562458100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.