Provider Demographics
NPI:1902036932
Name:JEFFERSON COUNTY COMMISSION
Entity Type:Organization
Organization Name:JEFFERSON COUNTY COMMISSION
Other - Org Name:COOPER GREEN MERCY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/MEDICAL DIRECTOR
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:205-930-3600
Mailing Address - Fax:205-930-3497
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:205-930-3600
Practice Address - Fax:205-930-3497
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JEFFERSON COUNTY COMMISSION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-24
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAPPLIED FOR273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit