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General NPI Number Information
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NPI Number | 1548357916
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF SOUTH ALABAMA HEALTH SERVICES FOUNDATION
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 11/07/2018
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Provider Practice Location Address
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Address Line | 307 UNIVERSITY BLVD N CCCB BLDG. #214
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City | MOBILE
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State | AL
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Zip | 36688-3053
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Country | US
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Telephone | 251-470-5842
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Fax | 251-470-5809
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Provider Business Mailing Address
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Address Line | PO BOX 40480
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City | MOBILE
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State | AL
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Zip | 36640-0480
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Country | US
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Telephone | 251-470-5842
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Fax | 251-470-5809
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Authorized Official
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Title or Position | CEO/CONTRACT OFFICER
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Name | GLEN OWEN BAILEY
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Credential |
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Telephone | 251-471-7118
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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