Basic Information
Provider Information
NPI: 1649301532
EntityType: 2
ReplacementNPI:  
OrganizationName: BHC-CENTRE
LastName:  
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Mailing Information
Address1: 395 NORTHWOOD DR
Address2:  
City: CENTRE
State: AL
PostalCode: 359601045
CountryCode: US
TelephoneNumber: 2569274900
FaxNumber: 2569279151
Practice Location
Address1: 200 BEACON PKWY W
Address2: SUITE 330
City: BIRMINGHAM
State: AL
PostalCode: 352093102
CountryCode: US
TelephoneNumber: 2057155943
FaxNumber: 2057155932
Other Information
ProviderEnumerationDate: 03/09/2007
LastUpdateDate: 10/10/2007
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: FAULKNER
AuthorizedOfficialFirstName: CHARLES
AuthorizedOfficialMiddleName: A
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 2057155901
IsSoleProprietor:  
IsOrganizationSubpart: Y
ParentOrganizationLBN: BAPITST HEALTH CENTERS, INC
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Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansInternal Medicine 
208000000X  N193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansPediatrics 
207Q00000X  Y193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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