Healthcare Provider Details

I. General information

NPI: 1467599399
Provider Name (Legal Business Name): THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ALABAMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 11/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 PETER BRYCE BLVD
TUSCALOOSA AL
35401-7421
US

IV. Provider business mailing address

750 PETER BRYCE BLVD
TUSCALOOSA AL
35401-7421
US

V. Phone/Fax

Practice location:
  • Phone: 205-348-6262
  • Fax: 205-348-4121
Mailing address:
  • Phone: 205-348-6262
  • Fax: 205-348-4121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TODD B WEST
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 205-348-0794