NPIMap

Organization Active NPI

Desselle Surgical Clinic, LLC

  • Specialist
  • Muscle Shoals, AL
National Provider Identifier
1992938930
Registry record updated Jan 6, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
25005 Issued in AL
Legal business name
DESSELLE SURGICAL CLINIC, LLC
Practice address
203 Avalon Ave
Suite 290
Muscle Shoals, AL 35661-2869
Phone
(256) 386-1125
Fax
(256) 386-1126
NPI assigned
Aug 25, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2010

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

Authorized official

Name
Diane H. Dawson
Title
Office Manager
Phone
(256) 386-1125

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 25005 AL Primary

Addresses

Primary practice location

203 Avalon Ave
Suite 290
Muscle Shoals, AL 35661-2869

Mailing address

203 Avalon Ave
Suite 290
Muscle Shoals, AL 35661-2855
Phone (256) 386-1125

Other identifiers 4

IdentifierTypeStateIssuer
1477478MedicaidLA
114470MedicaidAL
510-49740OtherALBLUE CROSS BLUE SHIELD
102I029080OtherALMEDICARE PTAN

National Provider Directory

National Provider Directory

Locations

203 Avalon Ave
Ste 290
Muscle Shoals, AL 35661
Phone (205) 386-1125

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1251158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1262736000000",
    "number": "1992938930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 AVALON AVE",
            "address_2": "SUITE 290",
            "city": "MUSCLE SHOALS",
            "state": "AL",
            "postal_code": "356612855",
            "telephone_number": "256-386-1125",
            "fax_number": "256-386-1126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 AVALON AVE",
            "address_2": "SUITE 290",
            "city": "MUSCLE SHOALS",
            "state": "AL",
            "postal_code": "356612869",
            "telephone_number": "256-386-1125",
            "fax_number": "256-386-1126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESSELLE SURGICAL CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-25",
        "last_updated": "2010-01-06",
        "status": "A",
        "authorized_official_last_name": "DAWSON",
        "authorized_official_first_name": "DIANE",
        "authorized_official_middle_name": "H.",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "256-386-1125"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "AL",
            "license": "25005",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1477478",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "114470",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "510-49740",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "102I029080",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Muscle Shoals, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2010; 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.