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Organization

NORTHPORT - CRNA

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MICHAEL G WILSON (DIRECTOR BUSINESS SERVICES)
(205) 343-8500
Entity
Organization

Contact information

Practice address
2700 HOSPITAL DR, NORTHPORT, AL 35476-3360
(205) 333-4500
Mailing address
PO BOX 661495, BIRMINGHAM, AL 35266-1495
(205) 979-5882
(205) 979-1248

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
124766
AL
01
DR7373
RR MCR
AL
Enumeration date
11/23/2010
Last updated
08/08/2014
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