Healthcare Provider Details

I. General information

NPI: 1366466781
Provider Name (Legal Business Name): UAB MEDICAL WEST ASC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

995 9TH AVE SW
BESSEMER AL
35022-4527
US

IV. Provider business mailing address

995 9TH AVE SW
BESSEMER AL
35022-4527
US

V. Phone/Fax

Practice location:
  • Phone: 205-481-7268
  • Fax: 205-481-7595
Mailing address:
  • Phone: 205-481-7268
  • Fax: 205-481-7595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberAL2004018
License Number StateAL

VIII. Authorized Official

Name: KEITH PENNINGTON
Title or Position: COO
Credential:
Phone: 205-481-7268