Healthcare Provider Details

I. General information

NPI: 1215929864
Provider Name (Legal Business Name): CITIZENS BAPTIST MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 04/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 STONE AVE
TALLADEGA AL
35160-2217
US

IV. Provider business mailing address

604 STONE AVE
TALLADEGA AL
35160-2217
US

V. Phone/Fax

Practice location:
  • Phone: 256-761-4371
  • Fax: 256-761-4543
Mailing address:
  • Phone: 205-715-5427
  • Fax: 205-715-5878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JOEL TAYLOR
Title or Position: CEO
Credential:
Phone: 256-761-4490