Provider Demographics
NPI:1962718650
Name:NORTHWEST ALABAMA SURGICAL SPECIALISTS, PC
Entity type:Organization
Organization Name:NORTHWEST ALABAMA SURGICAL SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-486-3800
Mailing Address - Street 1:PO BOX 1046
Mailing Address - Street 2:
Mailing Address - City:HALEYVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35565-1046
Mailing Address - Country:US
Mailing Address - Phone:205-486-3800
Mailing Address - Fax:205-486-3802
Practice Address - Street 1:42030 HIGHWAY 195
Practice Address - Street 2:SUITE C
Practice Address - City:HALEYVILLE
Practice Address - State:AL
Practice Address - Zip Code:35565-7054
Practice Address - Country:US
Practice Address - Phone:205-486-3800
Practice Address - Fax:205-486-3802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL22074208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty