1215913934 NPI number — BAPTIST HOME MEDICAL SERVICES, LLC

Table of content: (NPI 1215913934)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215913934 NPI number — BAPTIST HOME MEDICAL SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAPTIST HOME MEDICAL SERVICES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215913934
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
406 MEDICAL CENTER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JASPER
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35501-3400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-221-8200
Provider Business Mailing Address Fax Number:
205-221-8270

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
452 10TH AVE S
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35205-4500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-714-6050
Provider Business Practice Location Address Fax Number:
205-714-6085
Provider Enumeration Date:
12/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
PACE
Authorized Official First Name:
STEWART
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PRESIDENT, BOARD OF MANAGERS
Authorized Official Telephone Number:
205-414-7525

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  112324 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00440604 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00440609 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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