Provider Demographics
NPI:1316101769
Name:WEST ALABAMA PHYSICIAN ASSOCIATES, LLC
Entity type:Organization
Organization Name:WEST ALABAMA PHYSICIAN ASSOCIATES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CORP DIRECTOR, PHYSICIAN SERVICES
Authorized Official - Prefix:MR
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
Mailing Address - Street 2:SUITE 908
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-7423
Mailing Address - Country:US
Mailing Address - Phone:205-344-9393
Mailing Address - Fax:205-758-6750
Practice Address - Street 1:701 UNIVERSITY BLVD E
Practice Address - Street 2:SUITE 908
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-7423
Practice Address - Country:US
Practice Address - Phone:205-344-9393
Practice Address - Fax:205-758-6750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL332B00000X
208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL103891Medicaid
ALD03406OtherMEDICARE RAILROAD
AL103891Medicaid
AL6146490001Medicare NSC