MEDICARE: IMC-NORTH BALDWIN PRIMARY PLUS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013283530
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMC-NORTH BALDWIN PRIMARY PLUS, LLC

Provider Business Mailing Address
First Line	:	2115 HAND AVE
Second Line	:
City	:	BAY MINETTE
State	:	AL
Zip	:	36507-4149
Country	:	US
Telephone Number	:	251-937-7100
Fax Number	:

Provider Business Practice Location Address
First Line	:	2115 HAND AVE STE B
Second Line	:
City	:	BAY MINETTE
State	:	AL
Zip	:	36507-4149
Country	:	US
Telephone Number	:	251-937-7100
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT OF FINANCE
Name	:	MR. ANTHONY PALAZZO
Credential	:
Telephone Number	:	251-435-1331

Provider Enumeration Date	:	03/29/2012
Last Update Date	:	05/01/2024

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