Basic Information
| Provider Information | |||||||||
| NPI: | 1184688244 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BAPTIST HEALTH CENTERS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1130 22ND ST S STE 1000 | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352052881 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2057155943 | ||||||||
| FaxNumber: | 2057155932 | ||||||||
| Practice Location | |||||||||
| Address1: | 320 COOSA ST E | ||||||||
| Address2: | |||||||||
| City: | TALLADEGA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 351602276 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2563623636 | ||||||||
| FaxNumber: | 2563620002 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2006 | ||||||||
| LastUpdateDate: | 01/08/2018 | ||||||||
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| AuthorizedOfficialLastName: | JACKSON | ||||||||
| AuthorizedOfficialFirstName: | ROBIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2057155943 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 529402960 | 05 | AL | MEDICAID | 541003848 | 05 | AL | MEDICAID |