Provider Demographics
NPI: | 1972239440 |
---|---|
Name: | UNIVERSITY HEALTH ALLIANCE |
Entity Type: | Organization |
Organization Name: | UNIVERSITY HEALTH ALLIANCE |
Other - Org Name: | UNIVERSITY HEALTH ALLIANCE |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | LORETTA |
Authorized Official - Middle Name: | L |
Authorized Official - Last Name: | GOODSON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 706-353-5016 |
Mailing Address - Street 1: | 3320 OLD JEFFERSON RD BLDG 700 |
Mailing Address - Street 2: | |
Mailing Address - City: | ATHENS |
Mailing Address - State: | GA |
Mailing Address - Zip Code: | 30607-1465 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 706-353-2990 |
Mailing Address - Fax: | 706-353-2992 |
Practice Address - Street 1: | 3320 OLD JEFFERSON RD BLDG 800 |
Practice Address - Street 2: | |
Practice Address - City: | ATHENS |
Practice Address - State: | GA |
Practice Address - Zip Code: | 30607-1400 |
Practice Address - Country: | US |
Practice Address - Phone: | 706-353-2990 |
Practice Address - Fax: | 706-353-2992 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | UNIVERSITY CANCER & BLOOD CENTER, LLC |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2022-07-27 |
Last Update Date: | 2024-02-09 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Multi-Specialty |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207QA0505X | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine | Group - Multi-Specialty |
No | 207QH0002X | Allopathic & Osteopathic Physicians | Family Medicine | Hospice and Palliative Medicine | Group - Multi-Specialty |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | Group - Multi-Specialty |
No | 207RH0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology | Group - Multi-Specialty |
No | 207RH0002X | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine | Group - Multi-Specialty |
No | 207RX0202X | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | Group - Multi-Specialty |
No | 207ZP0102X | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | Group - Multi-Specialty |
No | 2085R0001X | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | Group - Multi-Specialty |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 2086X0206X | Allopathic & Osteopathic Physicians | Surgery | Surgical Oncology | Group - Multi-Specialty |
No | 208C00000X | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery | Group - Multi-Specialty |