Healthcare Provider Details

I. General information

NPI: 1467596205
Provider Name (Legal Business Name): TALLAPOOSA COUNTY HEALTH DEPT-ALEX CITY VFC IMMUN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2078 SPORTPLEX BLVD
ALEXANDER CITY AL
35010-4472
US

IV. Provider business mailing address

2078 SPORTPLEX BLVD
ALEXANDER CITY AL
35010-4472
US

V. Phone/Fax

Practice location:
  • Phone: 256-329-0531
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier486219999
Identifier TypeMEDICAID
Identifier StateAL
Identifier Issuer

VIII. Authorized Official

Name: REGINA L PATTERSON
Title or Position: DIRECTOR OF HEALTH SYSTEMS
Credential:
Phone: 334-206-5061