MEDICARE: NORTH BALDWIN PEDIATRICS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1396805461
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH BALDWIN PEDIATRICS LLC

Provider Business Mailing Address
First Line	:	2004 MEDICAL CENTER DR
Second Line	:
City	:	BAY MINETTE
State	:	AL
Zip	:	36507-4163
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2004 MEDICAL CENTER DR
Second Line	:
City	:	BAY MINETTE
State	:	AL
Zip	:	36507-4163
Country	:	US
Telephone Number	:	251-580-8475
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT OF FINANCE
Name	:	ANTHONY PALAZZO
Credential	:
Telephone Number	:	251-435-1361

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	02/03/2021

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