Provider Demographics
NPI:1033213624
Name:STATE OF ALABAMA DEPT OF FINANCE
Entity Type:Organization
Organization Name:STATE OF ALABAMA DEPT OF FINANCE
Other - Org Name:MARY STARKE HARPER GERIATRIC PSYCHIATRY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNTING ASSISTANT II
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-366-3038
Mailing Address - Street 1:PO BOX 21231
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35402
Mailing Address - Country:US
Mailing Address - Phone:205-366-3010
Mailing Address - Fax:205-366-3012
Practice Address - Street 1:115 HARPER COURT
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401
Practice Address - Country:US
Practice Address - Phone:205-366-3010
Practice Address - Fax:205-366-3012
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF ALABAMA DEPARTMENT OF FINANCE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-12
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
011659OtherBC CH
012803OtherBC
AL012803OtherBLUE CROSS BLUE SHIELD
ALGER0001HMedicaid