Basic Information
| Provider Information | |||||||||
| NPI: | 1073836334 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BAPTIST HEALTH CENTERS INC WALKER INPATIENT MEDICINE | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BAPTIST HOSPITALIST | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1130 22ND ST S STE 1000 | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352052881 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2057155943 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3400 HIGHWAY 78 E | ||||||||
| Address2: | |||||||||
| City: | JASPER | ||||||||
| State: | AL | ||||||||
| PostalCode: | 355018907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2053874401 | ||||||||
| FaxNumber: | 2053874717 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2010 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | NEAL | ||||||||
| AuthorizedOfficialFirstName: | VALETA | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2057155901 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BAPTIST HEALTH CENTERS, INC. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 117851 | 05 | AL | MEDICAID |