Healthcare Provider Details

I. General information

NPI: 1083709521
Provider Name (Legal Business Name): MOBILE COUNTY BOARD OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 04/29/2021
Certification Date: 04/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4009 SAINT STEPHENS RD
MOBILE AL
36612-1231
US

IV. Provider business mailing address

P.O BOX 2867
MOBILE AL
36652-2867
US

V. Phone/Fax

Practice location:
  • Phone: 251-456-1399
  • Fax: 251-456-0079
Mailing address:
  • Phone: 251-690-8158
  • Fax: 251-690-8853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: KELLY WARREN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 251-690-8158