1790875516 NPI number — MENTAL HEALTH BD OF BIBB PICKENS AND TUSCALOOSA COUNTIES

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 1790875516 NPI number — MENTAL HEALTH BD OF BIBB PICKENS AND TUSCALOOSA COUNTIES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MENTAL HEALTH BD OF BIBB PICKENS AND TUSCALOOSA COUNTIES
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:
1790875516
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2190
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUSCALOOSA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-391-3131
Provider Business Mailing Address Fax Number:
205-391-3137

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
140 COURT SQUARE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARROLLTON
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35447
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-367-8159
Provider Business Practice Location Address Fax Number:
205-391-3137
Provider Enumeration Date:
10/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
THRASHER
Authorized Official First Name:
BLAKE
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
205-391-3131

Provider Taxonomy Codes

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

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

  • Identifier: 051008111 . This is a "BCBS OF AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 528700510 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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