NPIMap

University of South Alabama

Organization Active NPI Multi-Specialty Clinic/Center · Mobile, AL

NPI 1992013593 · NPPES record last updated Apr 22, 2019

Key facts

NPI
1992013593
Entity type
Organization (NPI type 2)
Primary specialty
Multi-Specialty Clinic/Center 261QM1300X
Legal business name
UNIVERSITY OF SOUTH ALABAMA
Practice address
1119 Hahn
5721 USA North Drive
Mobile, AL 36688-0002
Phone
(251) 445-9378
Fax
(251) 445-9377
NPI assigned
Sep 16, 2010
Organization subpart
No

Authorized official

Name
Mr. Glen Owen Bailey
Title
Ceo/Contract Officer
Phone
(251) 471-7118

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Corporate family (same tax ID) 14

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in AL

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20040115000773 AL Part B Supplier - Clinic/Group Practice 3072425149 Receives reassigned benefits from 418 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Mobile, AL; Monroeville, AL; Fairhope, AL; Jackson, AL

National Provider Directory

Tax ID family
University of South Alabama Mitchell Cancer Institute (53 organizations share this tax ID)

Locations

1119 Hahn
Mobile, AL 36688

5721 Usa Dr N Hahn1119
Mobile, AL 36688

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Yes

Addresses

Primary practice location

1119 Hahn
5721 USA North Drive
Mobile, AL 36688-0002

Mailing address

PO Box 40480
Mobile, AL 36640-0480
Phone (251) 445-9378

Other names

  • USA Allied Health Professions Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 22, 2019.

{
    "created_epoch": "1284595200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1555891200000",
    "number": "1992013593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 40480",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366400480",
            "telephone_number": "251-445-9378",
            "fax_number": "251-445-9377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1119 HAHN",
            "address_2": "5721 USA NORTH DRIVE",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366880002",
            "telephone_number": "251-445-9378",
            "fax_number": "251-445-9377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY OF SOUTH ALABAMA",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-16",
        "last_updated": "2019-04-22",
        "status": "A",
        "authorized_official_last_name": "BAILEY",
        "authorized_official_first_name": "GLEN",
        "authorized_official_middle_name": "OWEN",
        "authorized_official_title_or_position": "CEO/CONTRACT OFFICER",
        "authorized_official_telephone_number": "251-471-7118",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "USA Allied Health Professions",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mobile, AL

All providers in Mobile, AL · Multi-Specialty Clinic/Center in Alabama

Sources for this page

Verify at the official NPI Registry.