Healthcare Provider Details

I. General information

NPI: 1922062082
Provider Name (Legal Business Name): BHC-SHELBY HOSPITALIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 04/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 1ST ST N
ALABASTER AL
35007-8703
US

IV. Provider business mailing address

PO BOX 830605
BIRMINGHAM AL
35283-0605
US

V. Phone/Fax

Practice location:
  • Phone: 205-620-7004
  • Fax: 205-620-8688
Mailing address:
  • Phone: 205-715-5943
  • Fax: 205-715-5932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: G. SCOTT FENN
Title or Position: PRESIDENT
Credential:
Phone: 205-715-5415