Provider Demographics
NPI:1386782787
Name:DECATUR SURGERY CENTER LP
Entity type:Organization
Organization Name:DECATUR SURGERY CENTER LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:HETRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-340-1212
Mailing Address - Street 1:PO BOX 747
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35602
Mailing Address - Country:US
Mailing Address - Phone:256-340-1212
Mailing Address - Fax:256-340-0252
Practice Address - Street 1:2828 HIGHWAY 31 SOUTH
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603
Practice Address - Country:US
Practice Address - Phone:256-340-1212
Practice Address - Fax:256-340-0252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALU5201261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALASC0002CMedicaid
ALD671Medicare PIN
AL00055052Medicare ID - Type Unspecified