Provider Demographics
NPI:1184666760
Name:SOUTH BALDWIN FAMILY PRACTICE LLC
Entity Type:Organization
Organization Name:SOUTH BALDWIN FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLIS
Authorized Official - Middle Name:S
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:251-943-7237
Mailing Address - Street 1:202 W ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-1942
Mailing Address - Country:US
Mailing Address - Phone:251-943-7237
Mailing Address - Fax:251-943-2451
Practice Address - Street 1:202 W ORANGE AVE
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-1942
Practice Address - Country:US
Practice Address - Phone:251-943-7237
Practice Address - Fax:251-943-2451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty