Provider Demographics
NPI:1467599399
Name:THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ALABAMA
Entity Type:Organization
Organization Name:THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ALABAMA
Other - Org Name:UA STUDENT HEALTH CENTER & PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:B
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-348-0794
Mailing Address - Street 1:750 PETER BRYCE BLVD
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-7421
Mailing Address - Country:US
Mailing Address - Phone:205-348-6262
Mailing Address - Fax:205-348-4121
Practice Address - Street 1:750 PETER BRYCE BLVD
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-7421
Practice Address - Country:US
Practice Address - Phone:205-348-6262
Practice Address - Fax:205-348-4121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL133063Medicaid