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General NPI Number Information
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NPI Number | 1205006723
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF SOUTH ALABAMA
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Dates
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Enumeration Date | 03/12/2008
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 307 UNIVERSITY BLVD N RESEARCH TECH PARK BUILDING 3/SUITE 1100
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City | MOBILE
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State | AL
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Zip | 36688-0002
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Country | US
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Telephone | 251-461-1805
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Fax |
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Provider Business Mailing Address
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Address Line | 307 UNIVERSITY DRIVE
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City | MOBILE
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State | AL
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Zip | 36688-0002
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Country | US
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Telephone | 251-461-1805
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Fax |
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Authorized Official
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Title or Position | ASSOC VP/CONTRACT OFFICER
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Name | ROBERT K. DAVIS
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Credential |
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Telephone | 251-414-8297
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State | AL
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