Provider Demographics
NPI:1699421024
Name:INFIRMARY ASC - FAIRHOPE, LLC
Entity type:Organization
Organization Name:INFIRMARY ASC - FAIRHOPE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RVP OF OPS
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-374-6496
Mailing Address - Street 1:7110 CROSSWOODS BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027
Mailing Address - Country:US
Mailing Address - Phone:615-550-2600
Mailing Address - Fax:
Practice Address - Street 1:411 N SECTION ST
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-2649
Practice Address - Country:US
Practice Address - Phone:614-374-6496
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical