| Samford University Student Health Services | |
|
800 Lakeshore Dr Birmingham AL 35229-0001 | |
| (205) 726-2835 | |
| (205) 726-4042 |
| Full Name | Samford University Student Health Services |
|---|---|
| Speciality | Clinic/Center |
| Location | 800 Lakeshore Dr, Birmingham, Alabama |
| Authorized Official Name and Position | Shauna N Yelton (DIRECTOR STUDENT HEALTH SERVICES) |
| Authorized Official Contact | 2057262835 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Samford University Student Health Services 800 Lakeshore Dr Birmingham AL 35229-0001 Ph: (205) 726-2835 | Samford University Student Health Services 800 Lakeshore Dr Birmingham AL 35229-0001 Ph: (205) 726-2835 |
| NPI Number | 1588716021 |
|---|---|
| Provider Enumeration Date | 01/17/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 4587838354 |
|---|---|
| Medicare Enrollment ID | O20111114000745 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588716021 | NPI | - | NPPES |
| PA-247 | Other | AL | STATE LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QS1000X | Clinic/center - Student Health | (* (Not Available)) | Primary |
| Provider Name | Leslie K Canfield |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891921250 PECOS PAC ID: 7810042777 Enrollment ID: I20090831000054 |
| Provider Name | Mark Ticola |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1942404504 PECOS PAC ID: 1951498401 Enrollment ID: I20111024000633 |
| Provider Name | Ashley Galbraith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285004382 PECOS PAC ID: 1850695800 Enrollment ID: I20160211001063 |
| Provider Name | Carie Nicole Tucker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639521339 PECOS PAC ID: 1254625981 Enrollment ID: I20160803001874 |
| Provider Name | Joseph W Brewer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1497167118 PECOS PAC ID: 8820218944 Enrollment ID: I20160916001273 |
| Provider Name | James Lee Martinez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699205385 PECOS PAC ID: 3173876083 Enrollment ID: I20181023001792 |
| Provider Name | Shawntavia Latrice Powe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861968760 PECOS PAC ID: 8527304237 Enrollment ID: I20190116001795 |
| Provider Name | Abby Ozment Goolsby |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407328123 PECOS PAC ID: 6103166780 Enrollment ID: I20190318002103 |
| Provider Name | Leslie Anne Edwards |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417265893 PECOS PAC ID: 3678908712 Enrollment ID: I20200116003104 |
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