Healthcare Provider Details

I. General information

NPI: 1720465461
Provider Name (Legal Business Name): MOBILE INFIRMARY ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2015
Last Update Date: 05/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 MOBILE INFIRMARY CIR
MOBILE AL
36607-3513
US

IV. Provider business mailing address

PO BOX 297
MONTROSE AL
36559-0297
US

V. Phone/Fax

Practice location:
  • Phone: 251-435-2400
  • Fax:
Mailing address:
  • Phone: 251-591-6240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number1-054817
License Number StateAL

VIII. Authorized Official

Name: DR. KENNETH BREWINGTON
Title or Position: VICE PRESIDENT ADMINISTRATOR
Credential: MD
Phone: 251-435-2400