1528452562 NPI number — OAKWOOD UNIVERSITY CHURCH HEALTH SERVICE

Table of content: (NPI 1528452562)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528452562 NPI number — OAKWOOD UNIVERSITY CHURCH HEALTH SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OAKWOOD UNIVERSITY CHURCH HEALTH SERVICE
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:
1528452562
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5500 ADVENTIST BLVD NW
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
HUNTSVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35896-0002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5500 ADVENTIST BLVD NW
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
HUNTSVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35896-0002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-203-5185
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/27/2015

Additional Information

Authorized Official

Authorized Official Last Name:
BYRD
Authorized Official First Name:
CARLTON
Authorized Official Middle Name:
Authorized Official Title or Position:
CHAIR OF BOARD
Authorized Official Telephone Number:
256-203-5185

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X , 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: 169275 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com