Provider Demographics
NPI:1124082789
Name:SHOALS SURGICAL GROUP LLC
Entity type:Organization
Organization Name:SHOALS SURGICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:COLLIGNON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:256-383-0423
Mailing Address - Street 1:1100 S JACKSON HWY STE 101
Mailing Address - Street 2:
Mailing Address - City:SHEFFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35660-5769
Mailing Address - Country:US
Mailing Address - Phone:256-772-6018
Mailing Address - Fax:256-383-0922
Practice Address - Street 1:1100 S JACKSON HWY STE 101
Practice Address - Street 2:
Practice Address - City:SHEFFIELD
Practice Address - State:AL
Practice Address - Zip Code:35660-5769
Practice Address - Country:US
Practice Address - Phone:256-772-6018
Practice Address - Fax:256-383-0922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529926510Medicaid
AL529926510Medicaid