Provider Demographics
NPI:1356911564
Name:DRUID CITY PHYSICIAN SERVICES, LLC
Entity type:Organization
Organization Name:DRUID CITY PHYSICIAN SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORP DIRECTOR, PHYSICIAN SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:CLAY
Authorized Official - Last Name:CONVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-759-6165
Mailing Address - Street 1:3901 GREENSBORO AVE STE A
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405-3771
Mailing Address - Country:US
Mailing Address - Phone:205-333-4661
Mailing Address - Fax:
Practice Address - Street 1:701 UNIVERSITY BLVD E STE 807
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-7479
Practice Address - Country:US
Practice Address - Phone:205-759-6873
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Single Specialty