Provider Demographics
NPI:1225283518
Name:JEFFERSON COUNTY COMMISSION
Entity Type:Organization
Organization Name:JEFFERSON COUNTY COMMISSION
Other - Org Name:COOPER GREEN HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRAL
Authorized Official - Middle Name:
Authorized Official - Last Name:HULLETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-930-3600
Mailing Address - Street 1:1515 6TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1601
Mailing Address - Country:US
Mailing Address - Phone:205-930-3214
Mailing Address - Fax:205-930-3546
Practice Address - Street 1:1515 6TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1601
Practice Address - Country:US
Practice Address - Phone:205-930-3214
Practice Address - Fax:205-930-3546
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JEFFERSON COUNTY COMMISSION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-01
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL010137Medicare PIN
AL102G709317Medicare UPIN