Provider Demographics
NPI:1861579336
Name:MATERNITY SERVICES OF DISTRICT 11, LLC
Entity type:Organization
Organization Name:MATERNITY SERVICES OF DISTRICT 11, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:JR
Authorized Official - Credentials:CFO
Authorized Official - Phone:334-528-1313
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36831-0189
Mailing Address - Country:US
Mailing Address - Phone:334-528-6830
Mailing Address - Fax:334-826-0238
Practice Address - Street 1:1365 GATEWOOD DR
Practice Address - Street 2:SUITE 525
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-2834
Practice Address - Country:US
Practice Address - Phone:334-528-6832
Practice Address - Fax:334-826-0238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization