1790896710 NPI number — MEDICAL WEST HOSPITAL AUTHORITY, AN AFFILIATE OF UAB HEALTH SYSTEM

Table of content: (NPI 1790896710)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790896710 NPI number — MEDICAL WEST HOSPITAL AUTHORITY, AN AFFILIATE OF UAB HEALTH SYSTEM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL WEST HOSPITAL AUTHORITY, AN AFFILIATE OF UAB HEALTH SYSTEM
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:
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:
1790896710
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/18/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
995 9TH AVE SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BESSEMER
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35022-4527
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-481-7670
Provider Business Mailing Address Fax Number:
205-481-7573

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
995 9TH AVE SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BESSEMER
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35022-4527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-481-7670
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SLOCUM
Authorized Official First Name:
BRANDON
Authorized Official Middle Name:
H
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
205-481-7134

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  12816 , 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: 010146 . This is a "BLUE CROSS OF AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 5000003 . This is a "MEDICARE COMPLETE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: HOS0114H , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10184 . This is a "HEALTHSPRINGS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 312687 . This is a "BLACK LUNG" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 5000003 . This is a "UNITED HEALTH" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 10184 . This is a "SENIORS FIRST" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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