MEDICARE: INSIGHT TREATMENT PROGRAM, INC

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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center		AL

General Provider Information

NPI Number	:	1184880734
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INSIGHT TREATMENT PROGRAM, INC

Provider Business Mailing Address
First Line	:	1111 E I65 SERVICE RD S
Second Line	:	SUITE A-7
City	:	MOBILE
State	:	AL
Zip	:	36606-3112
Country	:	US
Telephone Number	:	251-473-6093
Fax Number	:	251-473-6469

Provider Business Practice Location Address
First Line	:	100 COURT ST
Second Line	:
City	:	GROVE HILL
State	:	AL
Zip	:	36451-3263
Country	:	US
Telephone Number	:	251-275-3036
Fax Number	:	251-275-3721

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. THOMAS EUGENE LEE JR.
Credential	:	BS
Telephone Number	:	251-473-6093

Provider Enumeration Date	:	08/04/2008
Last Update Date	:	08/04/2008

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