Provider Demographics
NPI:1326182486
Name:MONTGOMERY BAPTIST OUTREACH SERVICES CORPORATION
Entity Type:Organization
Organization Name:MONTGOMERY BAPTIST OUTREACH SERVICES CORPORATION
Other - Org Name:HOSPITAL PHYSICIAN SERVICES OF CENTRAL ALABAMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:BRUTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-273-4258
Mailing Address - Street 1:440 TAYLOR RD
Mailing Address - Street 2:SUITE 3380
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-3588
Mailing Address - Country:US
Mailing Address - Phone:334-211-3628
Mailing Address - Fax:334-213-6288
Practice Address - Street 1:440 TAYLOR RD
Practice Address - Street 2:SUITE 3380
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-3588
Practice Address - Country:US
Practice Address - Phone:334-213-6287
Practice Address - Fax:334-213-6288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALCE1792OtherRAILROAD ROAD MEDICARE
AL529932869Medicaid
AL0113048OtherUNITED HEALTHCARE
ALG478OtherMEDICARE GROUP PROVIDER
AL529932869Medicaid
AL=========OtherWORK COMP
ALG478OtherMEDICARE GROUP PROVIDER
ALCE1792OtherRAILROAD ROAD MEDICARE