Healthcare Provider Details

I. General information

NPI: 1366073108
Provider Name (Legal Business Name): COOPER GREEN MERCY HEALTH SERVICES AUTHORITY AN AFFILIATE OF UAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2020
Last Update Date: 12/16/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 6TH AVE S
BIRMINGHAM AL
35233-1601
US

IV. Provider business mailing address

1509 6TH AVE S
BIRMINGHAM AL
35233-1601
US

V. Phone/Fax

Practice location:
  • Phone: 205-930-3200
  • Fax:
Mailing address:
  • Phone: 205-930-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: STEVE PAYNE
Title or Position: CFO
Credential:
Phone: 205-930-3200