1982747192 NPI number — STATE OF ALABAMA DEPARTMENT OF PUBLIC HEALTH

Table of content: (NPI 1982747192)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982747192 NPI number — STATE OF ALABAMA DEPARTMENT OF PUBLIC HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STATE OF ALABAMA DEPARTMENT OF PUBLIC HEALTH
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:
BUREAU OF CLINICAL LABS
Provider Other Organization Name Type Code:
3
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:
1982747192
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1000
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRATTVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36067-9901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
204 LEGENDS CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRATTVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36066-7893
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-290-6130
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/15/2007

Additional Information

			
		

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  01D0641691 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000060117 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".