1336167196 NPI number — JEFFERSON COUNTY BOARD OF HEALTH

Table of content: (NPI 1336167196)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336167196 NPI number — JEFFERSON COUNTY BOARD OF HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEFFERSON COUNTY BOARD OF 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:
CENTRAL HEALTH CENTER
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:
1336167196
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/12/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2648
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35202-2648
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-933-9110
Provider Business Mailing Address Fax Number:
205-930-1156

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 6TH AVE S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35233-1502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-933-9110
Provider Business Practice Location Address Fax Number:
205-930-1156
Provider Enumeration Date:
07/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CLARK
Authorized Official First Name:
SHEWANDA
Authorized Official Middle Name:
Authorized Official Title or Position:
REVENUE INTEGRITY SUPERVISOR
Authorized Official Telephone Number:
205-558-2158

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 528502060 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 227300000 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 227309999 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 303700000 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: G587 . This is a "MEDICARE GROUP NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51050506 . This is a "BLUE SHIELD OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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