MEDICARE: UNIVERSITY OF SOUTH ALABAMA HEALTH CARE AUTHORITY

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	208VP0000X	Pain Medicine Physician

General Provider Information

NPI Number	:	1851859938
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY OF SOUTH ALABAMA HEALTH CARE AUTHORITY

Provider Business Mailing Address
First Line	:	3929-1 AIRPORT BLVD
Second Line	:	5TH FLOOR, ROOM 513
City	:	MOBILE
State	:	AL
Zip	:	36609
Country	:	US
Telephone Number	:	251-318-2681
Fax Number	:	251-378-6222

Provider Business Practice Location Address
First Line	:	3290 DAUPHIN ST STE 204
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36606-4014
Country	:	US
Telephone Number	:	251-660-5900
Fax Number	:	251-660-5901

Authorized Official
Title or Position	:	CREDENTIALING
Name	:	ERICA MADISON
Credential	:
Telephone Number	:	251-318-2681

Provider Enumeration Date	:	03/07/2019
Last Update Date	:	04/07/2021

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Directions to “UNIVERSITY OF SOUTH ALABAMA HEALTH CARE AUTHORITY ” Practice Location

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