Basic Information
| Provider Information | |||||||||
| NPI: | 1922345438 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTH BALDWIN ANESTHESIA, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 235019 | ||||||||
| Address2: | |||||||||
| City: | MONTGOMERY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 361235019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3342791450 | ||||||||
| FaxNumber: | 3343954110 | ||||||||
| Practice Location | |||||||||
| Address1: | 1613 N MCKENZIE ST | ||||||||
| Address2: | |||||||||
| City: | FOLEY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 365352247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2519493400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2013 | ||||||||
| LastUpdateDate: | 01/04/2013 | ||||||||
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| AuthorizedOfficialLastName: | FLOWERS | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | AUTHORIZED REPRESENTATIVE | ||||||||
| AuthorizedOfficialTelephone: | 2519493400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | AL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.