Provider Demographics
NPI:1497816565
Name:JEFFERSON COUNTY BOARD OF HEALTH
Entity type:Organization
Organization Name:JEFFERSON COUNTY BOARD OF HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REVENUE INTEGRITY SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:SHEWANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-558-2158
Mailing Address - Street 1:PO BOX 2648
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35202-2648
Mailing Address - Country:US
Mailing Address - Phone:205-933-9110
Mailing Address - Fax:205-930-1156
Practice Address - Street 1:1400 6TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233
Practice Address - Country:US
Practice Address - Phone:205-933-9110
Practice Address - Fax:205-930-1156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL227300000Medicaid