MEDICARE: STATE 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	251K00000X	Public Health or Welfare Agency

General Provider Information

NPI Number	:	1346419702
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STATE OF ALABAMA

Provider Business Mailing Address
First Line	:	50 RIPLEY STREET
Second Line	:	FAMILY SERVICES DIVISION-OFRM
City	:	MONTGOMERY
State	:	AL
Zip	:	36130-4000
Country	:	US
Telephone Number	:	334-242-1310
Fax Number	:	334-242-0198

Provider Business Practice Location Address
First Line	:	1705 S HIGHWAY 31
Second Line	:
City	:	BAY MINETTE
State	:	AL
Zip	:	36507-2614
Country	:	US
Telephone Number	:	251-580-2800
Fax Number	:	251-580-2882

Authorized Official
Title or Position	:	DEPUTY COMMISSIONER FISCAL & ADMIN
Name	:	MR. PARRIS L. CORLEY
Credential	:
Telephone Number	:	334-242-8395

Provider Enumeration Date	:	02/29/2008
Last Update Date	:	02/29/2008

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Directions to “STATE OF ALABAMA ” Practice Location

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