Provider Demographics
NPI:1033449376
Name:VACCINATION SERVICES OF ALABAMA, LLC
Entity Type:Organization
Organization Name:VACCINATION SERVICES OF ALABAMA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:334-319-3279
Mailing Address - Street 1:804 HILLFLO AVE
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-2206
Mailing Address - Country:US
Mailing Address - Phone:334-319-3279
Mailing Address - Fax:
Practice Address - Street 1:804 HILLFLO AVE
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-2206
Practice Address - Country:US
Practice Address - Phone:334-319-3279
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1086070163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty