1174209233 NPI number — ALH PRE-ADMIT TESTING CLINIC

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 1174209233 NPI number — ALH PRE-ADMIT TESTING CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALH PRE-ADMIT TESTING CLINIC
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:
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:
1174209233
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22454 HWY 72
Provider Second Line Business Mailing Address:
STE 340
Provider Business Mailing Address City Name:
ATHENS
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35613
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-262-2132
Provider Business Mailing Address Fax Number:
256-262-2135

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22454 HWY 72
Provider Second Line Business Practice Location Address:
STE 340
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-262-2132
Provider Business Practice Location Address Fax Number:
256-262-2135
Provider Enumeration Date:
06/23/2023

Additional Information

Authorized Official

Authorized Official Last Name:
HOLT
Authorized Official First Name:
SEBRINA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF PHYSICIAN NETWORK
Authorized Official Telephone Number:
256-216-9648

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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