1760529721 NPI number — ALABAMA DEPARTMENT OF REHABILITATION SERVICES

Table of content: (NPI 1760529721)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760529721 NPI number — ALABAMA DEPARTMENT OF REHABILITATION SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALABAMA DEPARTMENT OF REHABILITATION SERVICES
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:
Provider Other Organization Name Type Code:
6
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:
1760529721
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2129 E SOUTH BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36116-2409
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-613-2200
Provider Business Mailing Address Fax Number:
334-613-1973

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2129 E SOUTH BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTGOMERY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36116-2409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-613-2200
Provider Business Practice Location Address Fax Number:
334-613-1973
Provider Enumeration Date:
01/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SHIVERS
Authorized Official First Name:
RUSSELL
Authorized Official Middle Name:
STEVEN
Authorized Official Title or Position:
COMMISSIONER
Authorized Official Telephone Number:
334-613-2200

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 515-18210 . This is a "NUTRITION" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-18212 . This is a "OPTHALMOLOGY" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-18214 . This is a "ORTHOPEDICS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-18220 . This is a "PSYCHIATRY-PSYCHOLOGY" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-18213 . This is a "ORAL MAXILOFACIAL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-18224 . This is a "SOCIAL WORKER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-18215 . This is a "OTOLARYNGOLOGY" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-18225 . This is a "SPEECH THERAPY" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-18209 . This is a "NURSE PRACTITIONER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-18219 . This is a "PLASTIC SURGERY" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-18222 . This is a "PULMONARY" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-18207 . This is a "NEPHROLOGY" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-18208 . This is a "NEUROLOGY" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-18211 . This is a "OCCUPATIONAL THERAPY" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-18218 . This is a "PHYSICAL THERAPY" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-18221 . This is a "RADIOLOGY" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-18216 . This is a "PEDIATRICS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-18217 . This is a "PHYSICAL MEDICINE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-18223 . This is a "RHEUMATOLOGY" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-18226 . This is a "UROLOGY" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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