Provider Demographics
NPI:1144755695
Name:ALABAMA DEPARTMENT OF PUBLIC HEALTH EHR MU
Entity Type:Organization
Organization Name:ALABAMA DEPARTMENT OF PUBLIC HEALTH EHR MU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STOUT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:334-206-2905
Mailing Address - Street 1:201 MONROE ST
Mailing Address - Street 2:SUITE 250, RSA TOWER
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36104-3735
Mailing Address - Country:US
Mailing Address - Phone:334-206-2905
Mailing Address - Fax:334-206-3998
Practice Address - Street 1:201 MONROE ST
Practice Address - Street 2:SUITE 250, RSA TOWER
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36104-3735
Practice Address - Country:US
Practice Address - Phone:334-206-2905
Practice Address - Fax:334-206-3998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-21
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty