MEDICARE: JEWELL H HALANYCH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	00025408	AL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	636005396005	OTHER		HUMANA GOLD CHOICE MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	051517650	OTHER	AL	BCBS

General Provider Information

NPI Number	:	1427018621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEWELL H HALANYCH M.D.

Provider Business Mailing Address
First Line	:	2055 E SOUTH BLVD
Second Line	:	SUITE 202
City	:	MONTGOMERY
State	:	AL
Zip	:	36116-2001
Country	:	US
Telephone Number	:	334-284-5211
Fax Number	:	334-284-9020

Provider Business Practice Location Address
First Line	:	2055 E SOUTH BLVD
Second Line	:	SUITE 202
City	:	MONTGOMERY
State	:	AL
Zip	:	36116-2002
Country	:	US
Telephone Number	:	334-284-5211
Fax Number	:	334-284-9020

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	01/10/2013

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Directions to “ JEWELL H HALANYCH M.D.” Practice Location

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