Basic Information
| Provider Information | |||||||||
| NPI: | 1104283738 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCONVILLE | ||||||||
| FirstName: | MICHAEL | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 830550 | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352830550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8772245809 | ||||||||
| FaxNumber: | 3343774417 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 1ST ST N | ||||||||
| Address2: | |||||||||
| City: | ALABASTER | ||||||||
| State: | AL | ||||||||
| PostalCode: | 350078703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8772245809 | ||||||||
| FaxNumber: | 3343774417 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2016 | ||||||||
| LastUpdateDate: | 01/27/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 1-127092 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.