Healthcare Provider Details

I. General information

NPI: 1528078219
Provider Name (Legal Business Name): UNIVERSITY OF ALABAMA HEALTH SERVICES FOUNDATION PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 6TH AVE S
BIRMINGHAM AL
35233-1802
US

IV. Provider business mailing address

PO BOX 55823
BIRMINGHAM AL
35255-5823
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-3460
  • Fax:
Mailing address:
  • Phone: 205-934-4948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JAN GENTRY
Title or Position: DIRECTOR PROFESSIONAL SERVICES
Credential:
Phone: 205-975-8850