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Organization

UNIVERSITY OF SOUTH ALABAMA HEALTH SERVICES FOUNDATION

Active
Other names
USA Clinical Genetics Lab
Organization subpart
No

Provider details

NPI number
Authorized official
GLEN OWEN BAILEY (CEO/CONTRACT OFFICER)
(251) 471-7118
Entity
Organization

Contact information

Practice address
307 UNIVERSITY BLVD N, CCCB BLDG. #214, MOBILE, AL 36688-3053
(251) 470-5842
(251) 470-5809
Mailing address
PO BOX 40480, MOBILE, AL 36640-0480
(251) 470-5842
(251) 470-5809

Taxonomy

Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00124456
MS
01
051054097
BCBS
AL
05
075487100
FL
05
09015722
MS
05
1881759
LA
05
530200801
AL
Enumeration date
10/06/2006
Last updated
11/07/2018
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