Healthcare Provider Details

I. General information

NPI: 1194496216
Provider Name (Legal Business Name): BLUE LAKE HEALTH SPRINGHILL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2021
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3719 DAUPHIN ST
MOBILE AL
36608-1753
US

IV. Provider business mailing address

DEPT #8322 PO BOX 11407
BIRMINGHAM AL
35246-8322
US

V. Phone/Fax

Practice location:
  • Phone: 251-344-9630
  • Fax:
Mailing address:
  • Phone: 205-848-2925
  • Fax: 334-377-4417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ROBERT PATRICK
Title or Position: CEO
Credential:
Phone: 205-977-1949