Basic Information
| Provider Information | |||||||||
| NPI: | 1053375204 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BHC - CENTERPOINT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 BEACON PKWY W | ||||||||
| Address2: | SUITE 330 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352093153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2057155910 | ||||||||
| FaxNumber: | 2057155928 | ||||||||
| Practice Location | |||||||||
| Address1: | 9709 PARKWAY E | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352157853 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2058361199 | ||||||||
| FaxNumber: | 2058360021 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2006 | ||||||||
| LastUpdateDate: | 07/11/2008 | ||||||||
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| AuthorizedOfficialLastName: | BLACKBURN | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | M. | ||||||||
| AuthorizedOfficialTitleorPosition: | INTERIM PRESIDENT & CEO | ||||||||
| AuthorizedOfficialTelephone: | 2057155910 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BAPTIST HEALTH CENTERS, INC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 528903000 | 05 | AL | MEDICAID |