1548357916 NPI number — UNIVERSITY OF SOUTH ALABAMA HEALTH SERVICES FOUNDATION

Table of content: (NPI 1548357916)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548357916 NPI number — UNIVERSITY OF SOUTH ALABAMA HEALTH SERVICES FOUNDATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF SOUTH ALABAMA HEALTH SERVICES FOUNDATION
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:
1548357916
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 40480
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:
36640-0480
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:
307 UNIVERSITY BLVD N
Provider Second Line Business Practice Location Address:
CCCB BLDG. #214
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36688-3053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-470-5842
Provider Business Practice Location Address Fax Number:
251-470-5809
Provider Enumeration Date:
10/06/2006

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00124456 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051054097 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 09015722 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 075487100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 530200801 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1881759 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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