Provider Demographics
NPI:1720761554
Name:UNIVERSITY OF ALABAMA HEALTH SERVICES FOUNDATION PC
Entity Type:Organization
Organization Name:UNIVERSITY OF ALABAMA HEALTH SERVICES FOUNDATION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE VP, CORPORATE ADMIN SVCS
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MCAVOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-731-9399
Mailing Address - Street 1:DEPT 8454
Mailing Address - Street 2:PO BOX 11407 C/O ORAL SURGERY AT INVERNESS
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-8454
Mailing Address - Country:US
Mailing Address - Phone:205-558-2500
Mailing Address - Fax:
Practice Address - Street 1:1 INVERNESS CENTER PKWY STE 200
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-4865
Practice Address - Country:US
Practice Address - Phone:205-776-0599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty