Provider Demographics
NPI:1780962399
Name:UNIVERSITY OF SOUTH ALABAMA, DEPARTMENT OF INTERNAL MEDICINE
Entity type:Organization
Organization Name:UNIVERSITY OF SOUTH ALABAMA, DEPARTMENT OF INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOUSESTAFF DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-471-7117
Mailing Address - Street 1:7250 PERKINS RD APT 223
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-9189
Mailing Address - Country:US
Mailing Address - Phone:225-354-6383
Mailing Address - Fax:
Practice Address - Street 1:7250 PERKINS RD APT 223
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-9189
Practice Address - Country:US
Practice Address - Phone:225-354-6383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-31
Last Update Date:2011-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital