Provider Demographics
NPI:1306613211
Name:THE DCH HEALTH CARE AUTHORITY
Entity type:Organization
Organization Name:THE DCH HEALTH CARE AUTHORITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORP 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 1:701 UNIVERSITY BLVD E STE 211
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-7431
Mailing Address - Country:US
Mailing Address - Phone:205-343-8200
Mailing Address - Fax:
Practice Address - Street 1:701 UNIVERSITY BLVD E STE 211
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-7431
Practice Address - Country:US
Practice Address - Phone:205-343-8200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE DCH HEALTH CARE AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center