Healthcare Provider Details

I. General information

NPI: 1114330008
Provider Name (Legal Business Name): WEST ALABAMA PHYSICIAN ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 02/17/2023
Certification Date: 02/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 UNIVERSITY BLVD E SUITE 604
TUSCALOOSA AL
35401-2086
US

IV. Provider business mailing address

3901 GREENSBORO AVE STE A
TUSCALOOSA AL
35405-3771
US

V. Phone/Fax

Practice location:
  • Phone: 205-759-6925
  • Fax: 205-759-6926
Mailing address:
  • Phone: 205-333-4661
  • Fax: 205-333-4660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DANIEL CONVILLE
Title or Position: MEMBER REPRESENTATIVE
Credential:
Phone: 205-759-6165