MEDICARE: CONECUH COUNTY HEALTH DEPT EPSDT

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

Other Identifiers

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

General Provider Information

NPI Number	:	1750424024
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONECUH COUNTY HEALTH DEPT EPSDT

Provider Business Mailing Address
First Line	:	PO BOX 110
Second Line	:
City	:	EVERGREEN
State	:	AL
Zip	:	36401-0110
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	526 BELLEVILLE ST
Second Line	:
City	:	EVERGREEN
State	:	AL
Zip	:	36401-3005
Country	:	US
Telephone Number	:	251-578-1952
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF HEALTH SYSTEMS
Name	:	REGINA L PATTERSON
Credential	:
Telephone Number	:	334-206-5061

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	09/20/2024

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