Provider Demographics
NPI:1104117068
Name:DCH PROVIDER SERVICES, LLC
Entity type:Organization
Organization Name:DCH PROVIDER SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, PHYSICIAN SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:CLAY
Authorized Official - Last Name:CONVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-759-6165
Mailing Address - Street 1:1110 DR EDWARD HILLARD DR STE A
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-7446
Mailing Address - Country:US
Mailing Address - Phone:205-333-4661
Mailing Address - Fax:205-333-4660
Practice Address - Street 1:809 UNIVERSITY BLVD E
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-2029
Practice Address - Country:US
Practice Address - Phone:205-333-4655
Practice Address - Fax:205-333-4660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-27
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL127803Medicaid
AL102G703566Medicare PIN