1174799308 NPI number — JEFFERSON-BLOUNT-ST. CLAIR MH/MR AUTHORITY

Table of content: (NPI 1174799308)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174799308 NPI number — JEFFERSON-BLOUNT-ST. CLAIR MH/MR AUTHORITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEFFERSON-BLOUNT-ST. CLAIR MH/MR AUTHORITY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
JBS MH/MR AUTHORITY
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174799308
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
940 MONTCLAIR RD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35213-1217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-595-4555
Provider Business Mailing Address Fax Number:
205-592-3539

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
940 MONTCLAIR RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35213-1217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-595-4555
Provider Business Practice Location Address Fax Number:
205-592-3539
Provider Enumeration Date:
05/07/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CRAIG
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
205-595-4555

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 330034017 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 330000017 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590000017 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008506000 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 515-11694 . This is a "BCBS ALL KIDS PLUS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".