Provider Demographics
NPI:1134273063
Name:ALABAMA DEPARTMENT OF REHABILITATION SERVICES
Entity type:Organization
Organization Name:ALABAMA DEPARTMENT OF REHABILITATION SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COMMISSION
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:SHIVERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-613-2200
Mailing Address - Street 1:2129 E SOUTH BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-2409
Mailing Address - Country:US
Mailing Address - Phone:334-613-2200
Mailing Address - Fax:334-613-1973
Practice Address - Street 1:2129 E SOUTH BLVD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-2409
Practice Address - Country:US
Practice Address - Phone:334-613-2200
Practice Address - Fax:334-613-1973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-18198OtherCOLON-RECTAL
AL515-18201OtherGASTROENTEROLOGY
AL515-18202OtherGENERAL SURGERY
AL515-18203OtherGENETICS
AL515-18205OtherINTERNAL MEDICINE
AL515-18200OtherDENTISTRY
AL515-18188OtherANESTHESIOLOGY
AL515-18190OtherAUDIOLOGY
AL515-18199OtherUNSPECIFIED
AL515-18204OtherHEMATOLOGY-ONCOLOGY
AL515-18191OtherCARDIOLOGY
AL515-18206OtherMEDICAL SUPPLY