Indian Hills Plastic Surgery PC

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

Legal business name

INDIAN HILLS PLASTIC SURGERY PC

Practice address

3601 Watermelon Rd
Northport, AL 35473-5138

Phone

(205) 333-4661

NPI assigned

Jun 8, 2022

Organization subpart

No

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

Authorized official

Name

Daniel Clay Conville

Title

Director, Physician Services

Phone

(205) 759-6165

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1654646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654646400000",
    "number": "1104555770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3901 GREENSBORO AVE STE A",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "354053771",
            "telephone_number": "205-759-6165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3601 WATERMELON RD",
            "city": "NORTHPORT",
            "state": "AL",
            "postal_code": "354735138",
            "telephone_number": "205-333-4661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIAN HILLS PLASTIC SURGERY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-08",
        "last_updated": "2022-06-08",
        "certification_date": "2022-06-08",
        "status": "A",
        "authorized_official_last_name": "CONVILLE",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "CLAY",
        "authorized_official_title_or_position": "DIRECTOR, PHYSICIAN SERVICES",
        "authorized_official_telephone_number": "205-759-6165"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Plastic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Plastic Surgery Physician in Northport, AL
• Providers in Northport, AL by specialty
• Plastic Surgery Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.