=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891723441
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BALDWIN PHYSICIAN SERVICES PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2006
-----------------------------------------------------
Last Update Date | 01/10/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1815 HAND AVE
-----------------------------------------------------
City | BAY MINETTE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36507-4110
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-435-2646
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 830529
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35283-0529
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO & SEC/TRES
-----------------------------------------------------
Name | WILLIAM E ADMIRE
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 251-435-2646
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------