Healthcare Provider Details

I. General information

NPI: 1164811758
Provider Name (Legal Business Name): OAKWOOD UNIVERSITY CHURCH HEALTH SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2015
Last Update Date: 01/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 ADVENTIST BLVD NW SUITE 103
HUNTSVILLE AL
35896-0002
US

IV. Provider business mailing address

5500 ADVENTIST BLVD NW SUITE 103
HUNTSVILLE AL
35896-0002
US

V. Phone/Fax

Practice location:
  • Phone: 256-203-5185
  • Fax: 256-203-5184
Mailing address:
  • Phone: 256-203-5185
  • Fax: 256-203-5184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number13621
License Number StateAL

VIII. Authorized Official

Name: DR. CHARLES VINCENT ANDERSON
Title or Position: PRESIDENT
Credential:
Phone: 256-203-5185