MEDICARE: ALABAMA HEALTHCARE ADVANTAGE SOUTH

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	:	1942665666
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALABAMA HEALTHCARE ADVANTAGE SOUTH

Provider Business Mailing Address
First Line	:	8650 MINNIE BROWN RD STE 224
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-7433
Country	:	US
Telephone Number	:	334-215-3985
Fax Number	:

Provider Business Practice Location Address
First Line	:	8650 MINNIE BROWN RD STE 224
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-7433
Country	:	US
Telephone Number	:	334-215-3985
Fax Number	:

Authorized Official
Title or Position	:	BOD PRESIDENT
Name	:	TODD W WHITNEY
Credential	:
Telephone Number	:	813-317-3536

Provider Enumeration Date	:	12/22/2015
Last Update Date	:	12/22/2015

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