MEDICARE: UNIVERSITY OF ALABAMA AT BIRMINGHAM HOSPITAL

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
1	282N00000X	General Acute Care Hospital	1-85113	AL

General Provider Information

NPI Number	:	1598052219
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY OF ALABAMA AT BIRMINGHAM HOSPITAL

Provider Business Mailing Address
First Line	:	510 20TH ST S # FOT1020
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35233-2028
Country	:	US
Telephone Number	:	205-934-1436
Fax Number	:	205-975-7546

Provider Business Practice Location Address
First Line	:	510 20TH ST S # FOT1020
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35233-2028
Country	:	US
Telephone Number	:	205-934-1436
Fax Number	:	205-975-7546

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	MRS. KATHERINE LINEBERRY MANGE
Credential	:	CRNP
Telephone Number	:	205-934-1436

Provider Enumeration Date	:	07/01/2011
Last Update Date	:	07/01/2011

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