Healthcare Provider Details

I. General information

NPI: 1013256650
Provider Name (Legal Business Name): UAB HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2013
Last Update Date: 02/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1424 MONTCLAIR RD
IRONDALE AL
35210-2208
US

IV. Provider business mailing address

1424 MONTCLAIR RD
IRONDALE AL
35210-2208
US

V. Phone/Fax

Practice location:
  • Phone: 205-951-1473
  • Fax:
Mailing address:
  • Phone: 205-951-1473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LILLIAN M MITCHELL
Title or Position: DENTAL DIRECTOR
Credential: DDS
Phone: 205-951-1473