Provider Demographics
NPI:1750353843
Name:STATE OF ALABAMA DEPT OF FINANCE STATE COMPTROLLER
Entity type:Organization
Organization Name:STATE OF ALABAMA DEPT OF FINANCE STATE COMPTROLLER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACTING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DR
Authorized Official - Phone:256-560-2201
Mailing Address - Street 1:4218 US HWY 31 S
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35603-5039
Mailing Address - Country:US
Mailing Address - Phone:256-560-2200
Mailing Address - Fax:256-560-2249
Practice Address - Street 1:4218 US HWY 31 S
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-5039
Practice Address - Country:US
Practice Address - Phone:256-560-2200
Practice Address - Fax:256-560-2249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-03
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL01-4009Medicare UPIN