MEDICARE: PHP OF ALABAMA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	302F00000X	Exclusive Provider Organization		AL

General Provider Information

NPI Number	:	1013916725
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHP OF ALABAMA

Provider Business Mailing Address
First Line	:	2352 CENTER POINT PKWY
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35215-3608
Country	:	US
Telephone Number	:	205-854-7272
Fax Number	:	205-854-7770

Provider Business Practice Location Address
First Line	:	2352 CENTER POINT PKWY
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35215-3608
Country	:	US
Telephone Number	:	205-854-7272
Fax Number	:	205-854-7770

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	MS. GLORIA SANFORD
Credential	:
Telephone Number	:	205-854-7272

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	08/22/2020

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Directions to “PHP OF ALABAMA ” Practice Location

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