Provider Demographics
NPI:1285771261
Name:BOARD OF TRUSTEES, UNIVERSITY OF ALABAMA
Entity type:Organization
Organization Name:BOARD OF TRUSTEES, UNIVERSITY OF ALABAMA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTING ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:DURRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-348-1832
Mailing Address - Street 1:BOX 870242
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35487-0242
Mailing Address - Country:US
Mailing Address - Phone:205-348-7131
Mailing Address - Fax:205-348-1845
Practice Address - Street 1:700 UNIV BLVD E
Practice Address - Street 2:ROOM 145
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-2028
Practice Address - Country:US
Practice Address - Phone:205-348-7131
Practice Address - Fax:205-348-1845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2017-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529100060Medicaid