Provider Demographics
NPI:1861837130
Name:UNIVERSITY OF ALABAMA AT BIRMINGHAM HOSPITAL (UAB)
Entity Type:Organization
Organization Name:UNIVERSITY OF ALABAMA AT BIRMINGHAM HOSPITAL (UAB)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEONATAL NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:NNP
Authorized Official - Phone:205-276-1053
Mailing Address - Street 1:216 W LINWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-3956
Mailing Address - Country:US
Mailing Address - Phone:205-879-6293
Mailing Address - Fax:
Practice Address - Street 1:1700 6TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1802
Practice Address - Country:US
Practice Address - Phone:205-934-7310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1091668282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital