Healthcare Provider Details

I. General information

NPI: 1639918410
Provider Name (Legal Business Name): DCH PROVIDER SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2024
Last Update Date: 05/22/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 UNIVERSITY BLVD E
TUSCALOOSA AL
35401-2029
US

IV. Provider business mailing address

3901 GREENSBORO AVE STE A
TUSCALOOSA AL
35405-3771
US

V. Phone/Fax

Practice location:
  • Phone: 205-759-6165
  • Fax:
Mailing address:
  • Phone: 205-759-6165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DANIEL CLAY CONVILLE
Title or Position: CORP DIRECTOR, PHYSICIAN SERVICES
Credential:
Phone: 205-759-6165