Healthcare Provider Details

I. General information

NPI: 1083629661
Provider Name (Legal Business Name): MOBILE COUNTY BOARD OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 04/29/2021
Certification Date: 04/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3810 WULFF RD E
SEMMES AL
36575-5256
US

IV. Provider business mailing address

PO BOX 2867
MOBILE AL
36652-2867
US

V. Phone/Fax

Practice location:
  • Phone: 251-445-0582
  • Fax: 251-445-0582
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