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NPI Code Detail

MEDICARE: STATE OF ALABAMA DEPARTMENT OF PUBLIC HEALTH

MEDICARE: STATE OF ALABAMA DEPARTMENT OF PUBLIC HEALTH
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
1251E00000XHome Health Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417035742
Entity Type Code : Organization
Provider Name (Legal Business Name) : STATE OF ALABAMA DEPARTMENT OF PUBLIC HEALTH
Provider Business Mailing Address
First Line : 201 MONROE ST
Second Line : THE RSA TOWER, SUITE 1200
City : MONTGOMERY
State : AL
Zip : 36104-3735
Country : US
Telephone Number : 334-206-5341
Fax Number : 334-206-5724
Provider Business Practice Location Address
First Line : 1850 CRAWFORD RD
Second Line :
City : PHENIX CITY
State : AL
Zip : 36867-4222
Country : US
Telephone Number : 334-298-5581
Fax Number : 334-291-0498
Authorized Official
Title or Position : STATE HOME CARE DIRECTOR
Name : GROVER T WEDGEWORTH
Credential :
Telephone Number : 334-206-5341
Provider Enumeration Date : 11/02/2006
Last Update Date : 07/27/2007

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Directions to “STATE OF ALABAMA DEPARTMENT OF PUBLIC HEALTH ” Practice Location

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