Provider Demographics
NPI:1396846739
Name:USCG
Entity Type:Organization
Organization Name:USCG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-441-6411
Mailing Address - Street 1:101 FOREMAN ROAD APT C34
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608
Mailing Address - Country:US
Mailing Address - Phone:707-364-0116
Mailing Address - Fax:
Practice Address - Street 1:USCG ATC MOBILE
Practice Address - Street 2:8501 TANNER WILLIAMS ROAD
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608
Practice Address - Country:US
Practice Address - Phone:251-441-6725
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization