Provider Demographics
NPI:1568864494
Name:UNIVERSITY OF MONTEVALLO
Entity Type:Organization
Organization Name:UNIVERSITY OF MONTEVALLO
Other - Org Name:MONTEVALLO SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEAD ATHLETICS TRAINER
Authorized Official - Prefix:
Authorized Official - First Name:MARCELO
Authorized Official - Middle Name:
Authorized Official - Last Name:GALAFASSI
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LAT, ATC
Authorized Official - Phone:205-665-6602
Mailing Address - Street 1:5050 SPRING VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-3995
Mailing Address - Country:US
Mailing Address - Phone:800-555-9073
Mailing Address - Fax:972-367-3452
Practice Address - Street 1:75 COLLEGE DR
Practice Address - Street 2:STATION 6060
Practice Address - City:MONTEVALLO
Practice Address - State:AL
Practice Address - Zip Code:35115-3732
Practice Address - Country:US
Practice Address - Phone:205-665-6602
Practice Address - Fax:972-367-3451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
No2080S0010XAllopathic & Osteopathic PhysiciansPediatricsSports MedicineGroup - Single Specialty