Healthcare Provider Details

I. General information

NPI: 1669534947
Provider Name (Legal Business Name): BHC-HOOVER FAMILY HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 09/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5295 PRESERVE PKWY SUITE 210
HOOVER AL
35244-4701
US

IV. Provider business mailing address

PO BOX 830605
BIRMINGHAM AL
35283-0605
US

V. Phone/Fax

Practice location:
  • Phone: 205-682-6077
  • Fax: 205-682-7746
Mailing address:
  • Phone: 205-715-5943
  • Fax: 205-715-5932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number27614
License Number StateAL

VIII. Authorized Official

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