Provider Demographics
NPI:1568081644
Name:COOPER GREEN MERCY HEALTH SERVICES AUTHORITY AN AFFILIATE OF UAB
Entity Type:Organization
Organization Name:COOPER GREEN MERCY HEALTH SERVICES AUTHORITY AN AFFILIATE OF UAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-731-9672
Mailing Address - Street 1:1515 6TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1601
Mailing Address - Country:US
Mailing Address - Phone:205-918-2353
Mailing Address - Fax:
Practice Address - Street 1:1515 6TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1601
Practice Address - Country:US
Practice Address - Phone:205-918-2353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COOPER GREEN MERCY HEALTH SERVICES AUTHORITY AN AFFILIATE OF UAB
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy