Basic Information
| Provider Information | |||||||||
| NPI: | 1821333535 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BHC-GASTROENTEROLOGY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 203 MEDICAL PARK OFC PARK | ||||||||
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| City: | TALLADEGA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 351602213 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 203 MEDICAL PARK OFC PARK | ||||||||
| Address2: | |||||||||
| City: | TALLADEGA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 351602213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2057155943 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2012 | ||||||||
| LastUpdateDate: | 12/06/2012 | ||||||||
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| AuthorizedOfficialLastName: | FENN | ||||||||
| AuthorizedOfficialFirstName: | GEORGE | ||||||||
| AuthorizedOfficialMiddleName: | SCOTT | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| 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 | 207RG0100X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.