Organization
SURGERY CENTER OF DECATUR LP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JENNIFER LATHRAM (ADMINISTRATOR)
(256) 560-2890
Entity
Organization
Contact information
Practice address
1122 14TH AVENUE SE, DECATUR, AL 35601-3361
(256) 560-2890
(256) 560-2891
Mailing address
PO BOX 1164, DECATUR, AL 35602-1164
(256) 560-2890
(256) 560-2891
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
12143
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ABC0073C
—
AL
Enumeration date
08/31/2006
Last updated
08/09/2013
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