Healthcare Provider Details

I. General information

NPI: 1922345438
Provider Name (Legal Business Name): SOUTH BALDWIN ANESTHESIA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2013
Last Update Date: 01/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1613 N MCKENZIE ST
FOLEY AL
36535-2247
US

IV. Provider business mailing address

PO BOX 235019
MONTGOMERY AL
36123-5019
US

V. Phone/Fax

Practice location:
  • Phone: 251-949-3400
  • Fax:
Mailing address:
  • Phone: 334-279-1450
  • Fax: 334-395-4110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateAL

VIII. Authorized Official

Name: JAMES E FLOWERS
Title or Position: AUTHORIZED REPRESENTATIVE
Credential: MD
Phone: 251-949-3400