1033213624 NPI number — STATE OF ALABAMA DEPT OF FINANCE

Table of content: (NPI 1033213624)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033213624 NPI number — STATE OF ALABAMA DEPT OF FINANCE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STATE OF ALABAMA DEPT OF FINANCE
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:
MARY STARKE HARPER GERIATRIC PSYCHIATRY 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:
1033213624
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 21231
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:
35402
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-366-3010
Provider Business Mailing Address Fax Number:
205-366-3012

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 HARPER COURT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUSCALOOSA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-366-3010
Provider Business Practice Location Address Fax Number:
205-366-3012
Provider Enumeration Date:
09/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHAW
Authorized Official First Name:
MELISSA
Authorized Official Middle Name:
D
Authorized Official Title or Position:
ACCOUNTING ASSISTANT II
Authorized Official Telephone Number:
205-366-3038

Provider Taxonomy Codes

  • Taxonomy code: 283Q00000X , 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: 011659 . This is a "BC CH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 012803 . This is a "BC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 012803 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: GER0001H , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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