1285771261 NPI number — BOARD OF TRUSTEES, UNIVERSITY OF ALABAMA

Table of content: (NPI 1285771261)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285771261 NPI number — BOARD OF TRUSTEES, UNIVERSITY OF ALABAMA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOARD OF TRUSTEES, UNIVERSITY OF ALABAMA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285771261
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/28/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
BOX 870242
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUSCALOOSA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35487-0242
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-348-7131
Provider Business Mailing Address Fax Number:
205-348-1845

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 UNIV BLVD E
Provider Second Line Business Practice Location Address:
ROOM 145
Provider Business Practice Location Address City Name:
TUSCALOOSA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35401-2028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-348-7131
Provider Business Practice Location Address Fax Number:
205-348-1845
Provider Enumeration Date:
01/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DURRETT
Authorized Official First Name:
MARY
Authorized Official Middle Name:
Authorized Official Title or Position:
ACCOUNTING ASSISTANT
Authorized Official Telephone Number:
205-348-1832

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 231H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 529100060 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com