Provider Demographics
NPI:1811280654
Name:UNIVERSITY OF ALABAMA AT BIRMINGHAM
Entity type:Organization
Organization Name:UNIVERSITY OF ALABAMA AT BIRMINGHAM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHEAL
Authorized Official - Middle Name:ROONEY
Authorized Official - Last Name:WALDRUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-934-7087
Mailing Address - Street 1:619 19TH ST S
Mailing Address - Street 2:CPMC 409, ATTN: BARBARA HARRIS
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35249-0018
Mailing Address - Country:US
Mailing Address - Phone:205-602-5256
Mailing Address - Fax:
Practice Address - Street 1:619 19TH ST S
Practice Address - Street 2:CPMC 409, ATTN: BARBARA HARRIS
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35249-0018
Practice Address - Country:US
Practice Address - Phone:205-602-5256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNVIERSITY OF ALABAMA AT BIRMINGHAM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty