Healthcare Provider Details

I. General information

NPI: 1184688244
Provider Name (Legal Business Name): BAPTIST HEALTH CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 01/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 COOSA ST E
TALLADEGA AL
35160-2276
US

IV. Provider business mailing address

1130 22ND ST S STE 1000
BIRMINGHAM AL
35205-2881
US

V. Phone/Fax

Practice location:
  • Phone: 256-362-3636
  • Fax: 256-362-0002
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 Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBIN JACKSON
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 205-715-5943