Provider Demographics
NPI:1417408238
Name:UNIVERSITY OF SOUTH ALABAMA CHILDREN'S AND WOMEN'S HOSPITAL
Entity Type:Organization
Organization Name:UNIVERSITY OF SOUTH ALABAMA CHILDREN'S AND WOMEN'S HOSPITAL
Other - Org Name:UNIVERSITY OF SOUTH ALABAMA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICAL THERAPIST ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LA SONJA
Authorized Official - Middle Name:CHEREESE
Authorized Official - Last Name:CAVER-EATON
Authorized Official - Suffix:
Authorized Official - Credentials:LPTA
Authorized Official - Phone:251-415-1670
Mailing Address - Street 1:673 S UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-7877
Mailing Address - Country:US
Mailing Address - Phone:251-665-7019
Mailing Address - Fax:
Practice Address - Street 1:673 S. UNIVERSITY BLVD.
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-7877
Practice Address - Country:US
Practice Address - Phone:251-665-7019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1159282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren