Provider Demographics
NPI:1972558864
Name:COLON & RECTAL SURGICAL ASSOCIATES OF BIRMINGHAM, P.C.
Entity type:Organization
Organization Name:COLON & RECTAL SURGICAL ASSOCIATES OF BIRMINGHAM, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:TRUETT
Authorized Official - Last Name:GUFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD,FACS
Authorized Official - Phone:205-933-1199
Mailing Address - Street 1:3400 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:35209-5604
Mailing Address - Country:US
Mailing Address - Phone:205-933-1199
Mailing Address - Fax:866-491-5373
Practice Address - Street 1:3400 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:AL
Practice Address - Zip Code:35209-5604
Practice Address - Country:US
Practice Address - Phone:205-933-1199
Practice Address - Fax:866-491-5373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15312 & 23439174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529924730Medicaid
AL529924730Medicaid
ALK482Medicare PIN
ALG95086Medicare UPIN
ALE90184Medicare UPIN