Provider Demographics
NPI:1164811758
Name:OAKWOOD UNIVERSITY CHURCH HEALTH SERVICE
Entity Type:Organization
Organization Name:OAKWOOD UNIVERSITY CHURCH HEALTH SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-203-5185
Mailing Address - Street 1:5500 ADVENTIST BLVD NW
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35896-0002
Mailing Address - Country:US
Mailing Address - Phone:256-203-5185
Mailing Address - Fax:256-203-5184
Practice Address - Street 1:5500 ADVENTIST BLVD NW
Practice Address - Street 2:SUITE 103
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35896-0002
Practice Address - Country:US
Practice Address - Phone:256-203-5185
Practice Address - Fax:256-203-5184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-20
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13621364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Single Specialty