Basic Information
| Provider Information | |||||||||
| NPI: | 1790756237 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BIRMINGHAM SURGERY CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2621 19TH ST S | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352091913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2052718200 | ||||||||
| FaxNumber: | 2052718332 | ||||||||
| Practice Location | |||||||||
| Address1: | 2621 19TH ST S | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352091913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2052718200 | ||||||||
| FaxNumber: | 2052718332 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2006 | ||||||||
| LastUpdateDate: | 09/12/2022 | ||||||||
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| AuthorizedOfficialLastName: | BALDOCK | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
| AuthorizedOfficialMiddleName: | BOYD | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICER AND AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 6152345935 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 09986 | AL | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | 000029229 | 05 | AL | MEDICAID | ASC0079C | 05 | AL | MEDICAID |