Provider Demographics
NPI:1699027680
Name:SAMFORD UNIVERSITY
Entity Type:Organization
Organization Name:SAMFORD UNIVERSITY
Other - Org Name:SAMFORD UNIVERSITY ATHLETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, BUSINESS & FINANCIAL AFFAIRS
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:B
Authorized Official - Last Name:BROCK
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:205-726-2811
Mailing Address - Street 1:800 LAKESHORE DR
Mailing Address - Street 2:HANNA CENTER, RM 1105
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35229-0001
Mailing Address - Country:US
Mailing Address - Phone:205-726-2811
Mailing Address - Fax:
Practice Address - Street 1:800 LAKESHORE DR
Practice Address - Street 2:HANNA CENTER, RM 1105
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35229-0001
Practice Address - Country:US
Practice Address - Phone:205-726-2811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health