Basic Information
| Provider Information | |||||||||
| NPI: | 1386684801 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GENERAL SURGERY ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4704 WHITESBURG DR SE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358021631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2568804510 | ||||||||
| FaxNumber: | 2568804512 | ||||||||
| Practice Location | |||||||||
| Address1: | 4704 WHITESBURG DR SE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358021631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2568804510 | ||||||||
| FaxNumber: | 2568804512 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2006 | ||||||||
| LastUpdateDate: | 07/14/2011 | ||||||||
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| AuthorizedOfficialLastName: | WILSON | ||||||||
| AuthorizedOfficialFirstName: | PETER | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2568804510 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 529502500 | 05 | AL | MEDICAID | CC7854 | 01 | AL | RAILROAD MEDICARE | OTHER |