Organization
SURGERY CLINIC, LLC
Active
Parent organization
SURGERY CLINIC, LLC
Other names
Surgery Clinic, LLC - Jacksonville
Organization subpart
Yes
Provider details
NPI number
Legal business name
SURGERY CLINIC, LLC
Authorized official
MRS. DIANETTE KEENER (BILLING MANAGER)
(256) 547-6331
Entity
Organization
Contact information
Practice address
1622 CHURCH AVE SE, JACKSONVILLE, AL 36265-3200
(256) 547-6331
(256) 547-1711
Mailing address
419 S 5TH ST, GADSDEN, AL 35901-5101
(256) 547-6331
(256) 547-1711
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
528202650
—
AL
Enumeration date
07/13/2015
Last updated
02/10/2021
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