Healthcare Provider Details

I. General information

NPI: 1356642045
Provider Name (Legal Business Name): DCH MEDICAL CENTER CRNA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2010
Last Update Date: 08/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 UNIVERSITY BLVD E
TUSCALOOSA AL
35401-2029
US

IV. Provider business mailing address

PO BOX 660257
BIRMINGHAM AL
35266-0257
US

V. Phone/Fax

Practice location:
  • Phone: 205-343-8500
  • Fax: 205-759-6397
Mailing address:
  • Phone: 205-979-5882
  • Fax: 205-979-1248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL G WILSON
Title or Position: DIRECTOR BUSINESS SERVICES
Credential:
Phone: 205-343-8500