Provider Demographics
NPI:1356336838
Name:SAWYER SURGERY CLINIC LLC
Entity type:Organization
Organization Name:SAWYER SURGERY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:PICKRON
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:334-393-3212
Mailing Address - Street 1:101 E BRUNSON ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330
Mailing Address - Country:US
Mailing Address - Phone:334-393-3212
Mailing Address - Fax:334-393-4979
Practice Address - Street 1:101 E BRUNSON ST
Practice Address - Street 2:SUITE 300
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330
Practice Address - Country:US
Practice Address - Phone:334-393-3212
Practice Address - Fax:334-393-4979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-12
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529912520Medicaid
AL529912520Medicaid