Healthcare Provider Details

I. General information

NPI: 1477997104
Provider Name (Legal Business Name): UNIVERSITY OF ALABAMA AT BIRMINGHAM MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2013
Last Update Date: 04/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 19TH ST S
BIRMINGHAM AL
35233-1900
US

IV. Provider business mailing address

FOT 1030 1720 2ND AVE S 1030
BIRMINGHAM AL
35294-3410
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-3411
  • Fax:
Mailing address:
  • Phone: 205-934-1439
  • Fax: 205-975-6081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number1-060325
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number1-060325
License Number StateAL

VIII. Authorized Official

Name: MISS LINDA KAY DAVIS
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 205-934-1439