Healthcare Provider Details

I. General information

NPI: 1144258237
Provider Name (Legal Business Name): MANAGED HEALTH CARE ADMINISTRATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2868 ACTON RD
BIRMINGHAM AL
35243-2502
US

IV. Provider business mailing address

2868 ACTON RD
BIRMINGHAM AL
35243-2502
US

V. Phone/Fax

Practice location:
  • Phone: 205-968-8360
  • Fax: 205-968-8375
Mailing address:
  • Phone: 205-968-8360
  • Fax: 205-968-8375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MR. RUSSELL L ADAMS
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 205-968-8360