Provider Demographics
NPI:1649354143
Name:UNIVERSITY OF SOUTH ALABAMA HEALTH SERVICES FOUNDATION
Entity type:Organization
Organization Name:UNIVERSITY OF SOUTH ALABAMA HEALTH SERVICES FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:S
Authorized Official - Last Name:TATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-470-5842
Mailing Address - Street 1:PO BOX 40480
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0480
Mailing Address - Country:US
Mailing Address - Phone:251-470-5842
Mailing Address - Fax:251-470-5809
Practice Address - Street 1:3421 MEDICAL PARK DR
Practice Address - Street 2:TWO MEDICAL PARK
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36693-3330
Practice Address - Country:US
Practice Address - Phone:251-665-8200
Practice Address - Fax:251-660-8210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51534549OtherBCBS
AL009942310Medicaid
AL=========OtherEMPLOYER ID
AL=========OtherEMPLOYER ID
AL009942310Medicaid