Provider Demographics
NPI:1114330008
Name:WEST ALABAMA PHYSICIAN ASSOCIATES LLC
Entity Type:Organization
Organization Name:WEST ALABAMA PHYSICIAN ASSOCIATES LLC
Other - Org Name:WEST ALABAMA TRAUMA SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER REPRESENTATIVE
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CONVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-759-6165
Mailing Address - Street 1:3901 GREENSBORO AVE STE A
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405-3771
Mailing Address - Country:US
Mailing Address - Phone:205-333-4661
Mailing Address - Fax:205-333-4660
Practice Address - Street 1:701 UNIVERSITY BLVD E
Practice Address - Street 2:SUITE 604
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-2086
Practice Address - Country:US
Practice Address - Phone:205-759-6925
Practice Address - Fax:205-759-6926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-09
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma SurgeryGroup - Single Specialty
No207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty