Healthcare Provider Details

I. General information

NPI: 1841421757
Provider Name (Legal Business Name): DCH PROVIDER SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2009
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1653 TEMPLE AVE N
FAYETTE AL
35555-1314
US

IV. Provider business mailing address

1110 DR EDWARD HILLARD DR STE A
TUSCALOOSA AL
35401-7446
US

V. Phone/Fax

Practice location:
  • Phone: 205-932-1280
  • Fax: 205-932-1260
Mailing address:
  • Phone: 205-333-4661
  • Fax: 205-333-4660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL CLAY CONVILLE
Title or Position: DIRECTOR, PHYSICIAN SERVICES
Credential:
Phone: 205-759-6165