Healthcare Provider Details

I. General information

NPI: 1700607116
Provider Name (Legal Business Name): ALABAMA CARE NETWORK MID-STATE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2024
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 20TH ST N STE 1100
BIRMINGHAM AL
35203-3216
US

IV. Provider business mailing address

417 20TH ST N STE 1100
BIRMINGHAM AL
35203-3216
US

V. Phone/Fax

Practice location:
  • Phone: 833-296-5245
  • Fax:
Mailing address:
  • Phone: 833-296-5245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: ANNA VELASCO
Title or Position: SECRETARY
Credential:
Phone: 833-296-5245