Provider Demographics
NPI:1093385379
Name:ALABAMA AGRICULTURE AND MECHANICAL UNIVERSITY
Entity Type:Organization
Organization Name:ALABAMA AGRICULTURE AND MECHANICAL UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ERNST
Authorized Official - Middle Name:
Authorized Official - Last Name:CEBERT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:256-929-2036
Mailing Address - Street 1:4900 MERIDIAN ST NW
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:AL
Mailing Address - Zip Code:35762-7500
Mailing Address - Country:US
Mailing Address - Phone:256-583-3696
Mailing Address - Fax:
Practice Address - Street 1:4900 MERIDIAN ST NW
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:AL
Practice Address - Zip Code:35762-7500
Practice Address - Country:US
Practice Address - Phone:256-583-3696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-29
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity HealthGroup - Multi-Specialty
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty