Basic Information
| Provider Information | |||||||||
| NPI: | 1588878854 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HEALTHCARE AUTHORITY OF UAB HIGHLANDS AN AFFILIATE OF UAB HEALTH SYSTE | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | UAB HIGHLANDS EMERGENCY PHYSICIANS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 11407 DRAWER 1432 | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352461432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059757389 | ||||||||
| FaxNumber: | 2059754662 | ||||||||
| Practice Location | |||||||||
| Address1: | 1201 11TH AVE S | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352053410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2054376098 | ||||||||
| FaxNumber: | 2054375998 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2007 | ||||||||
| LastUpdateDate: | 03/05/2010 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | PATTERSON | ||||||||
| AuthorizedOfficialFirstName: | ANTHONY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 2059307100 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HEALTHCARE AUTHORITY OF UAB HIGHLANDS AN AFFILIATE OF UAB HEALTH SYSTE | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | C096 | 01 | AL | BCBS | OTHER | 529932905 | 05 | AL | MEDICAID |