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NPI Code Detail

MEDICARE: UNIVERSITY OF SOUTH ALABAMA

MEDICARE: UNIVERSITY OF SOUTH ALABAMA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1293D00000XPhysiological Laboratory

General Provider Information

NPI Number : 1457007635
Entity Type Code : Organization
Provider Name (Legal Business Name) : UNIVERSITY OF SOUTH ALABAMA
Provider Business Mailing Address
First Line : 307 UNIVERSITY BLVD ADMIN BLDG 170
Second Line :
City : MOBILE
State : AL
Zip : 36688-0001
Country : US
Telephone Number : 251-445-9131
Fax Number :
Provider Business Practice Location Address
First Line : 181 HILLCREST RD STE B
Second Line :
City : MOBILE
State : AL
Zip : 36608-5306
Country : US
Telephone Number : 251-341-4656
Fax Number :
Authorized Official
Title or Position : CFO
Name : BENNY JOSEPH STOVER
Credential :
Telephone Number : 251-445-9164
Provider Enumeration Date : 02/25/2022
Last Update Date : 03/17/2022

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Directions to “UNIVERSITY OF SOUTH ALABAMA ” Practice Location

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