Provider Demographics
NPI:1619265303
Name:UNIVERSITY SOUTH ALABAMA CHILDREN'S AND WOMEN'S HOSPITAL
Entity Type:Organization
Organization Name:UNIVERSITY SOUTH ALABAMA CHILDREN'S AND WOMEN'S HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COLLABORATING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HAMAYUN
Authorized Official - Middle Name:
Authorized Official - Last Name:IMRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-405-5115
Mailing Address - Street 1:1700 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36604-3301
Mailing Address - Country:US
Mailing Address - Phone:251-415-1540
Mailing Address - Fax:251-415-1028
Practice Address - Street 1:1700 CENTER ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-3301
Practice Address - Country:US
Practice Address - Phone:251-415-1540
Practice Address - Fax:251-415-1028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-114977282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren