Basic Information
| Provider Information | |||||||||
| NPI: | 1669436705 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BHC - OCCUPATIONAL MEDICINE REHAB | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 830605 | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352830605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2057155904 | ||||||||
| FaxNumber: | 2057155928 | ||||||||
| Practice Location | |||||||||
| Address1: | 833 PRINCETON AVE SW | ||||||||
| Address2: | POB III; SUITE 150 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352111323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2057812699 | ||||||||
| FaxNumber: | 2057812690 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2006 | ||||||||
| LastUpdateDate: | 03/05/2009 | ||||||||
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| AuthorizedOfficialLastName: | FENN | ||||||||
| AuthorizedOfficialFirstName: | G. | ||||||||
| AuthorizedOfficialMiddleName: | SCOTT | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF INTEGRATION OFFICIER | ||||||||
| AuthorizedOfficialTelephone: | 2057155415 | ||||||||
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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 | 2083X0100X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine |
ID Information
| ID | Type | State | Issuer | Description | 529702460 | 05 | AL | MEDICAID |