1437258373 NPI number — UNIVERSITY OF ALABAMA AT BIRMINGHAM

Table of content: (NPI 1437258373)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437258373 NPI number — UNIVERSITY OF ALABAMA AT BIRMINGHAM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF ALABAMA AT BIRMINGHAM
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:
COMMUNITY HLTH SVCS-FAMILY PHY
Provider Other Organization Name Type Code:
3
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:
1437258373
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/12/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1201 11TH AVE S
Provider Second Line Business Mailing Address:
3RD FLOOR PHARMACY
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35205-3410
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-930-7585
Provider Business Mailing Address Fax Number:
205-930-7587

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
930 20TH ST S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35205-2610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-975-7792
Provider Business Practice Location Address Fax Number:
205-975-6962
Provider Enumeration Date:
09/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PETERSON
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF AMBULATORY OPERATI
Authorized Official Telephone Number:
205-934-7862

Provider Taxonomy Codes

  • Taxonomy code: 3336C0002X , with the licence number:  111175 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1993075 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100010012 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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