Provider Demographics
NPI:1417408659
Name:UNIVERSITY OF SOUTH ALABAMA
Entity Type:Organization
Organization Name:UNIVERSITY OF SOUTH ALABAMA
Other - Org Name:UNIVERSITY OF SOUTH ALABAMA ANESTHESIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:OWEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-471-7110
Mailing Address - Street 1:PO BOX 40010
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0010
Mailing Address - Country:US
Mailing Address - Phone:251-434-3505
Mailing Address - Fax:
Practice Address - Street 1:2451 FILLINGIM ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36617-2238
Practice Address - Country:US
Practice Address - Phone:251-471-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF SOUTH ALABAMA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty