Provider Demographics
NPI:1558437905
Name:JEFFERSON COUNTY BOARD OF HEALTH
Entity Type:Organization
Organization Name:JEFFERSON COUNTY BOARD OF HEALTH
Other - Org Name:EASTERN DENTAL
Other - Org Type:Doing Business As
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:205-510-3405
Mailing Address - Fax:205-510-3474
Practice Address - Street 1:601 WEST BLVD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35206-1300
Practice Address - Country:US
Practice Address - Phone:205-510-3405
Practice Address - Fax:205-510-3474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
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
AL529917440Medicaid