=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013482355
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALABAMA DEPT OF PUBLIC HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2018
-----------------------------------------------------
Last Update Date | 09/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 HEALTH CENTER DR
-----------------------------------------------------
City | CLANTON
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35045-2349
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-755-1287
-----------------------------------------------------
Fax | 205-755-2027
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 201 MONROE STREET RSA TOWER, SUITE 1200
-----------------------------------------------------
City | MONTGOMERY
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-206-5677
-----------------------------------------------------
Fax | 334-206-5985
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | STATE HEALTH OFFICER
-----------------------------------------------------
Name | DR. THOMAS MILLER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 334-206-5200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------