Basic Information
Provider Information
NPI: 1861403594
EntityType: 2
ReplacementNPI:  
OrganizationName: MOBILE COUNTY BOARD OF HEALTH
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: THE WOMEN'S CENTER
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 2867
Address2:  
City: MOBILE
State: AL
PostalCode: 366522867
CountryCode: US
TelephoneNumber: 2516908158
FaxNumber: 2516908853
Practice Location
Address1: 248 COX ST
Address2: SUITE B
City: MOBILE
State: AL
PostalCode: 366043303
CountryCode: US
TelephoneNumber: 2516908930
FaxNumber: 2516907371
Other Information
ProviderEnumerationDate: 08/10/2006
LastUpdateDate: 04/29/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: WARREN
AuthorizedOfficialFirstName: KELLY
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: EXECUTIVE DIRECTOR
AuthorizedOfficialTelephone: 2516908158
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/29/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QF0400X  Y Ambulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)

ID Information
IDTypeStateIssuerDescription
63000501305AL MEDICAID


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