MEDICARE: ALABAMA WOMENS CENTER FOR REPRODUCTIVE ALTERNATIVES

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	261QA0005X	Ambulatory Family Planning Facility	C4502	AL

General Provider Information

NPI Number	:	1891099958
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALABAMA WOMENS CENTER FOR REPRODUCTIVE ALTERNATIVES

Provider Business Mailing Address
First Line	:	612 MADISON ST SE
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35801-4401
Country	:	US
Telephone Number	:	256-536-2231
Fax Number	:	256-536-4634

Provider Business Practice Location Address
First Line	:	612 MADISON ST SE
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35801-4401
Country	:	US
Telephone Number	:	256-536-2231
Fax Number	:	256-536-4634

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. DALTON CHRISTOPHER JOHNSON
Credential	:
Telephone Number	:	256-536-2231

Provider Enumeration Date	:	01/04/2011
Last Update Date	:	01/04/2011

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