Basic Information
| Provider Information | |||||||||
| NPI: | 1487096475 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNIVERSITY OF ALABAMA HEALTH SERVICES FOUNDATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 838 MOUNTAIN BRANCH LN | ||||||||
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| City: | VESTAVIA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352261804 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1600 7TH AVE S | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352331711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2056389100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2013 | ||||||||
| LastUpdateDate: | 07/19/2013 | ||||||||
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| AuthorizedOfficialLastName: | CHEN | ||||||||
| AuthorizedOfficialFirstName: | MIKE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF OF PEDIATRIC SURGERY | ||||||||
| AuthorizedOfficialTelephone: | 2056389688 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC2000X | 1-112928 | AL | Y | Hospitals | General Acute Care Hospital | Children |
No ID Information.