Healthcare Provider Details

I. General information

NPI: 1073679692
Provider Name (Legal Business Name): UNIVERSITY OF ALABAMA AT BIRMINGHAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 09/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 19TH ST S ABC 1516
BIRMINGHAM AL
35249-1900
US

IV. Provider business mailing address

619 19TH ST S ABC 1516
BIRMINGHAM AL
35249-1900
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-3645
  • Fax: 205-934-4504
Mailing address:
  • Phone: 205-934-3645
  • Fax: 205-934-4504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416A0800X
TaxonomyAir Ambulance
License Number002497
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number002497
License Number StateAL

VIII. Authorized Official

Name: MRS. MARY BETH BRISCOE
Title or Position: CFO
Credential:
Phone: 205-934-2620