NPIMap

Organization Active NPI

Montgomery Eye Surgery Center LLC

Doing business as Montgomery Eye Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Montgomery, AL
National Provider Identifier
1053510933
Registry record updated Sep 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
U5103 Issued in AL
Legal business name
MONTGOMERY EYE SURGERY CENTER LLC
Doing business as
Montgomery Eye Surgery Center
Practice address
2752 Zelda Rd
Montgomery, AL 36106-2694
Phone
(334) 270-6977
Fax
(334) 213-0622
NPI assigned
Jul 12, 2007
Last updated
Sep 7, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Phillip A Clendenin
Title
President
Phone
(615) 665-1283

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X U5103 AL Primary

Addresses

Primary practice location

2752 Zelda Rd
Montgomery, AL 36106-2694

Mailing address

2752 Zelda Rd
Montgomery, AL 36106-2694
Phone (334) 270-6977

Other names 1

  • Montgomery Eye Surgery Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051129000840 AL Part B Supplier - Clinic/Group Practice 4486674991 Receives reassigned benefits from 6 practitioners
Practice locations: Montgomery, AL

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Montg Eye Surg Ctr-Anes2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

2752 Zelda Rd
Montgomery, AL 36106
Phone (334) 270-9677

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1184198400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694044800000",
    "number": "1053510933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2752 ZELDA RD",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361062694",
            "telephone_number": "334-270-6977",
            "fax_number": "334-213-0622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2752 ZELDA RD",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361062694",
            "telephone_number": "334-270-6977",
            "fax_number": "334-213-0622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTGOMERY EYE SURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-12",
        "last_updated": "2023-09-07",
        "status": "A",
        "authorized_official_last_name": "CLENDENIN",
        "authorized_official_first_name": "PHILLIP",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "615-665-1283",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "AL",
            "license": "U5103",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Montgomery Eye Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Montgomery, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.