Provider Demographics
NPI:1386194454
Name:PATRIOT PERIOPERATIVE PARTNERS, INC.
Entity type:Organization
Organization Name:PATRIOT PERIOPERATIVE PARTNERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-213-8420
Mailing Address - Street 1:3104 BLUE LAKE DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35243-2345
Mailing Address - Country:US
Mailing Address - Phone:334-247-8769
Mailing Address - Fax:334-377-4417
Practice Address - Street 1:2868 ACTON RD
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35243-2502
Practice Address - Country:US
Practice Address - Phone:334-247-8769
Practice Address - Fax:334-377-4417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty