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General NPI Number Information
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NPI Number | 1700241015
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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 | 12/31/2015
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Last Update Date | 04/02/2020
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Provider Practice Location Address
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Address Line | 2451 UNIVERSITY HOSPITAL DR MASTIN 102
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City | MOBILE
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State | AL
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Zip | 36617-2300
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Country | US
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Telephone | 251-470-5890
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Fax |
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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 | MR. 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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207ZC0500X
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Taxonomy Name | Cytopathology Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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