Provider Demographics
NPI:1144961293
Name:UNIVERSITY OF ALABAMA IN HUNTSVILLE
Entity type:Organization
Organization Name:UNIVERSITY OF ALABAMA IN HUNTSVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-824-6948
Mailing Address - Street 1:301 SPARKMAN DR NW # WIL325
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35805-1911
Mailing Address - Country:US
Mailing Address - Phone:256-824-6948
Mailing Address - Fax:
Practice Address - Street 1:301 SPARKMAN DR NW # WIL325
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35805-1911
Practice Address - Country:US
Practice Address - Phone:256-824-6948
Practice Address - Fax:256-824-6722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-05
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service