Provider Demographics
NPI:1952731408
Name:ALABAMA A&M UNIVERSITY
Entity Type:Organization
Organization Name:ALABAMA A&M UNIVERSITY
Other - Org Name:AAMU SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF SPORTS MEDICINE
Authorized Official - Prefix:
Authorized Official - First Name:JESSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUCNICK-KIMBUGWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-372-8458
Mailing Address - Street 1:PO BOX 1597
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:AL
Mailing Address - Zip Code:35762-1597
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4900 MERIDIAN STREE
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:AL
Practice Address - Zip Code:35762
Practice Address - Country:US
Practice Address - Phone:256-372-4001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-20
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health