| Name: | Clinic for Colon and Rectal Surgery, P.A. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Association |
| Status: | Exists |
| Date of registration: | 18 Nov 1976 (48 years ago) |
| Entity Number: | 000-043-422 |
| Register Number: | 000043422 |
| County: | Madison |
| Place of Formation: | Madison County |
| Principal Address: | 115 MANNING DR SW STE D101HUNTSVILLE, AL 35801 |
| Principal Address ZIP Code: | 35801 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1518918739 | 2006-05-12 | 2022-04-04 | 115 MANNING DR SW, SUITE D101, HUNTSVILLE, AL, 358014315, US | 115 MANNING DR SW, SUITE D101, HUNTSVILLE, AL, 358014315, US | |||||||||||||||||||||||
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| Phone | +1 256-533-6070 |
| Fax | 2565339374 |
| Fax | 2565334839 |
Authorized person
| Name | ROBERT H CAMPBELL JR. |
| Role | PRESIDENT |
| Phone | 2565336070 |
Taxonomy
| Taxonomy Code | 208C00000X - Colon & Rectal Surgery Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 529001580 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| GOLZARIAN, JAVAD | Member | 115 MANNING DR SW STE D101HUNTSVILLE, AL 35801 |
| CAMPBELL, ROBERT H JR | Member | 115 MANNING DR SW STE D101HUNTSVILLE, AL 35801 |
| CLARK, STEPHEN F | Member | 3109 ARBORSHADE TRACEOWENS CROSS ROADS, AL 35763 |
| SPINDLER, BLAKE | Member | 115 MANNING DR SW STE D101HUNTSVILLE, AL 35801 |
Date of last update: 30 Jul 2024
Sources: Alabama Secretary of State
