Provider Demographics
NPI:1285808584
Name:BAPTIST HEALTH CENTERS, LLC
Entity type:Organization
Organization Name:BAPTIST HEALTH CENTERS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-715-5943
Mailing Address - Street 1:1130 22ND ST S
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-2870
Mailing Address - Country:US
Mailing Address - Phone:205-715-5943
Mailing Address - Fax:205-715-5932
Practice Address - Street 1:724 STONE AVE
Practice Address - Street 2:
Practice Address - City:TALLADEGA
Practice Address - State:AL
Practice Address - Zip Code:35160-2219
Practice Address - Country:US
Practice Address - Phone:256-362-1410
Practice Address - Fax:256-362-0186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL166700Medicaid