Organization
MORA SURGICAL CLINIC, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. APRIL TILLER (OFFICE MANAGER)
(334) 361-6126
Entity
Organization
Contact information
Practice address
841 GILLESPIE ST, PRATTVILLE, AL 36067-3609
(334) 361-6126
(334) 361-6177
Mailing address
841 GILLESPIE ST, PRATTVILLE, AL 36067-3609
(334) 361-6126
(334) 361-6177
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
20392
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51501010
BLUE CROSS BLUE SHIELD
AL
05
—
51501010
—
AL
Enumeration date
02/07/2007
Last updated
08/22/2020
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