Healthcare Provider Details

I. General information

NPI: 1699019539
Provider Name (Legal Business Name): DCH HEALTHCARE AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 12/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 UNIVERSITY BLVD EAST
TUSCALOOSA AL
35401-2029
US

IV. Provider business mailing address

1820 RICE MINE ROAD NORTH SUITE 200
TUSCALOOSA AL
35406-3282
US

V. Phone/Fax

Practice location:
  • Phone: 205-759-7800
  • Fax: 205-750-5092
Mailing address:
  • Phone: 205-333-4655
  • Fax: 205-333-4660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFF D CAPLES
Title or Position: DIRECTOR OF PHYSICIAN SERVICES
Credential:
Phone: 205-333-4655