1023210259 NPI number — UNIVERSITY OF SOUTH ALABAMA MITCHELL CANCER INSTITUTE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023210259 NPI number — UNIVERSITY OF SOUTH ALABAMA MITCHELL CANCER INSTITUTE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF SOUTH ALABAMA MITCHELL CANCER INSTITUTE
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:
1023210259
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 40430
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:
36640-0430
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-470-5842
Provider Business Mailing Address Fax Number:
251-470-5809

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1660 SPRINGHILL AVE
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-665-8000
Provider Business Practice Location Address Fax Number:
251-665-8010
Provider Enumeration Date:
06/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BUSH
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
B
Authorized Official Title or Position:
ASST VP/CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
251-471-7114

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: G332 . This is a "BCBS COMMON PAY" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 529932818 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01256281 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2026 www.npivalidator.com