Provider Demographics
NPI:1023210259
Name:UNIVERSITY OF SOUTH ALABAMA MITCHELL CANCER INSTITUTE
Entity Type:Organization
Organization Name:UNIVERSITY OF SOUTH ALABAMA MITCHELL CANCER INSTITUTE
Other - Org Name:USA MITCHELL CANCER INSTITUTE
Other - Org Type:Other Name
Authorized Official - Title/Position:ASST VP/CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:BUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-471-7114
Mailing Address - Street 1:PO BOX 40430
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0430
Mailing Address - Country:US
Mailing Address - Phone:251-470-5842
Mailing Address - Fax:251-470-5809
Practice Address - Street 1:1660 SPRINGHILL AVE
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604
Practice Address - Country:US
Practice Address - Phone:251-665-8000
Practice Address - Fax:251-665-8010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALG332OtherBCBS COMMON PAY
AL529932818Medicaid
MS01256281Medicaid
ALG332OtherBCBS COMMON PAY
MS01256281Medicaid