Provider Demographics
NPI:1508392432
Name:UNIVERSITY OF SOUTH ALABAMA HEALTH CARE AUTHORITY
Entity Type:Organization
Organization Name:UNIVERSITY OF SOUTH ALABAMA HEALTH CARE AUTHORITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE & ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:G
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:WELDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-460-7500
Mailing Address - Street 1:307 N UNIVERSITY BLVD
Mailing Address - Street 2:AD 170
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36688-0002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6300 USA HEALTH BLVD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608
Practice Address - Country:US
Practice Address - Phone:251-633-8880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty