Provider Demographics
NPI:1073032488
Name:MOBILE COUNTY BOARD OF HEALTH
Entity type:Organization
Organization Name:MOBILE COUNTY BOARD OF HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR MCHD/FHCS
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, CEO
Authorized Official - Phone:251-690-8832
Mailing Address - Street 1:PO BOX 2867
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36652-2867
Mailing Address - Country:US
Mailing Address - Phone:251-690-8158
Mailing Address - Fax:
Practice Address - Street 1:251 N BAYOU ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36603-5827
Practice Address - Country:US
Practice Address - Phone:251-690-8151
Practice Address - Fax:251-544-2188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-18
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL630000013Medicaid