Provider Demographics
NPI:1376603050
Name:JEFFERSON COUNTY BOARD OF HEALTH
Entity Type:Organization
Organization Name:JEFFERSON COUNTY BOARD OF HEALTH
Other - Org Name:JEFFERSON COUNTY HEALTH DEPT WESTERN NURSE PRACTITIONER
Other - Org Type:Other Name
Authorized Official - Title/Position:REVENUE INTEGRITY SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:SHEWANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-558-2158
Mailing Address - Street 1:PO BOX 2648
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35202-2648
Mailing Address - Country:US
Mailing Address - Phone:205-715-6121
Mailing Address - Fax:205-241-5260
Practice Address - Street 1:631 BESSEMER SUPER HWY
Practice Address - Street 2:
Practice Address - City:MIDFIELD
Practice Address - State:AL
Practice Address - Zip Code:35228
Practice Address - Country:US
Practice Address - Phone:205-715-6121
Practice Address - Fax:205-241-5260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL227330000Medicaid