Healthcare Provider Details

I. General information

NPI: 1255410031
Provider Name (Legal Business Name): STATE OF ALABAMA DEPARTMENT OF PUBLIC HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 LOGAN AVE SW
CULLMAN AL
35055-4520
US

IV. Provider business mailing address

201 MONROE ST THE RSA TOWER, SUITE 1200
MONTGOMERY AL
36104-3735
US

V. Phone/Fax

Practice location:
  • Phone: 256-734-0258
  • Fax: 256-734-1840
Mailing address:
  • Phone: 334-206-5341
  • Fax: 334-206-5724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

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

# 1
IdentifierCUL9975A
Identifier TypeOTHER
Identifier StateAL
Identifier IssuerBIOMONITORING PROVIDER #

VIII. Authorized Official

Name: GROVER T WEDGEWORTH
Title or Position: STATE HOME CARE DIRECTOR
Credential:
Phone: 334-206-5341