Provider Demographics
NPI:1972797686
Name:VITAL SURG LLC
Entity type:Organization
Organization Name:VITAL SURG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-516-7123
Mailing Address - Street 1:1321 19TH ST S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-4801
Mailing Address - Country:US
Mailing Address - Phone:205-516-7123
Mailing Address - Fax:
Practice Address - Street 1:1321 19TH ST S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-4801
Practice Address - Country:US
Practice Address - Phone:205-516-7123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty