Provider Demographics
NPI:1083678130
Name:BHC - PRINCETON OB/GYN
Entity Type:Organization
Organization Name:BHC - PRINCETON OB/GYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:FENN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-715-5901
Mailing Address - Street 1:PO BOX 830605
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35283-0605
Mailing Address - Country:US
Mailing Address - Phone:205-715-5943
Mailing Address - Fax:205-715-5932
Practice Address - Street 1:1925 AVENUE E
Practice Address - Street 2:
Practice Address - City:ENSLEY
Practice Address - State:AL
Practice Address - Zip Code:35218-1619
Practice Address - Country:US
Practice Address - Phone:205-783-5164
Practice Address - Fax:205-783-5167
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAPTIST HEALTH CENTERS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-14
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529402530Medicaid
AL529402530Medicaid