1023055191 NPI number — UNIVERSITY OF SOUTH ALABAMA

Table of content: (NPI 1023055191)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023055191 NPI number — UNIVERSITY OF SOUTH ALABAMA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF SOUTH 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:
USA HEALTH CHILDREN'S & WOMEN'S HOSPITAL
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:
1023055191
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1700 CENTER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOBILE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36604-3301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-415-1000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1700 CENTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36604-3301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-415-1000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BAILEY
Authorized Official First Name:
GLEN
Authorized Official Middle Name:
OWEN
Authorized Official Title or Position:
CONTRACT OFFICER/CEO
Authorized Official Telephone Number:
251-471-7118

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  11847 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282NC2000X , with the licence number: 11847 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 282NW0100X , with the licence number: 11847 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: HOS3301H , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00020197 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010281401 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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