Healthcare Provider Details

I. General information

NPI: 1639557986
Provider Name (Legal Business Name): UAB NEUROSURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2015
Last Update Date: 05/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 20TH ST S # FOT1038
BIRMINGHAM AL
35233-2028
US

IV. Provider business mailing address

257 LINWOOD RD
STERRETT AL
35147-7026
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-7170
  • Fax: 205-975-6088
Mailing address:
  • Phone: 205-587-5699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number1-133313
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number1-133313
License Number StateAL

VIII. Authorized Official

Name: MICHEL THOMAS
Title or Position: SUPERVISOR
Credential:
Phone: 205-934-7170