Provider Demographics
NPI:1053416347
Name:STATE OF ALABAMA DEPARTMENT OF FINANCE
Entity type:Organization
Organization Name:STATE OF ALABAMA DEPARTMENT OF FINANCE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/FACILITY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCSHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-507-8300
Mailing Address - Street 1:1651 RUBY TYLER PARKWAY
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35404-2990
Mailing Address - Country:US
Mailing Address - Phone:205-507-8000
Mailing Address - Fax:205-507-8352
Practice Address - Street 1:1651 RUBY TYLER PARKWAY
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-2990
Practice Address - Country:US
Practice Address - Phone:205-507-8000
Practice Address - Fax:205-507-8352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL014007Medicare Oscar/Certification