1679513428 NPI number — JEFFERSON COUNTY COMMISSION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679513428 NPI number — JEFFERSON COUNTY COMMISSION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEFFERSON COUNTY COMMISSION
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:
JEFFERSON HEALTH SYSTEM PHARMACY
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:
1679513428
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/05/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
COOPER GREEN MERCY HEALTH SERVICES
Provider Second Line Business Mailing Address:
1515 6TH AVE S
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35233
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-930-3244
Provider Business Mailing Address Fax Number:
205-930-3648

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1515 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:
35233-1601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-930-3244
Provider Business Practice Location Address Fax Number:
205-930-3648
Provider Enumeration Date:
06/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HILL
Authorized Official First Name:
ANNA
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACY MANAGER
Authorized Official Telephone Number:
205-918-2353

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0002X , with the licence number: 113162 , 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: 100003668 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1991528 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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