Healthcare Provider Details

I. General information

NPI: 1013283530
Provider Name (Legal Business Name): IMC-NORTH BALDWIN PRIMARY PLUS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2012
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 HAND AVE STE B
BAY MINETTE AL
36507-4149
US

IV. Provider business mailing address

2115 HAND AVE
BAY MINETTE AL
36507-4149
US

V. Phone/Fax

Practice location:
  • Phone: 251-937-7100
  • Fax:
Mailing address:
  • Phone: 251-937-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ANTHONY PALAZZO
Title or Position: VICE PRESIDENT OF FINANCE
Credential:
Phone: 251-435-1331