Healthcare Provider Details

I. General information

NPI: 1336196856
Provider Name (Legal Business Name): BREWTON MEDICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2006
Last Update Date: 07/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 BELLEVILLE AVE
BREWTON AL
36426-1505
US

IV. Provider business mailing address

PO BOX 648
BREWTON AL
36427-0648
US

V. Phone/Fax

Practice location:
  • Phone: 251-867-6071
  • Fax: 251-867-5999
Mailing address:
  • Phone: 251-867-6071
  • Fax: 251-867-5999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: VICTOR HUNT JR.
Title or Position: ADMINISTRATOR
Credential:
Phone: 251-867-6071