Provider Demographics
NPI:1528078219
Name:UNIVERSITY OF ALABAMA HEALTH SERVICES FOUNDATION PC
Entity type:Organization
Organization Name:UNIVERSITY OF ALABAMA HEALTH SERVICES FOUNDATION PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR PROFESSIONAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GENTRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-975-8850
Mailing Address - Street 1:PO BOX 55823
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35255-5823
Mailing Address - Country:US
Mailing Address - Phone:205-934-4948
Mailing Address - Fax:
Practice Address - Street 1:1700 6TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1802
Practice Address - Country:US
Practice Address - Phone:205-934-3460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty