Provider Demographics
NPI:1326173147
Name:STATE OF ALABAMA DEPARTMENT OF PUBLIC HEALTH
Entity Type:Organization
Organization Name:STATE OF ALABAMA DEPARTMENT OF PUBLIC HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT STATE HEALTH OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-206-2940
Mailing Address - Street 1:201 MONROE ST
Mailing Address - Street 2:SUITE 940
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36104-3735
Mailing Address - Country:US
Mailing Address - Phone:334-206-2940
Mailing Address - Fax:334-206-2950
Practice Address - Street 1:201 MONROE ST
Practice Address - Street 2:SUITE 940
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36104-3735
Practice Address - Country:US
Practice Address - Phone:334-206-2940
Practice Address - Fax:334-206-2950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10408251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL104078Medicaid