Provider Demographics
NPI:1326388158
Name:BAPTIST HEALTH CENTER PRINCETON CARDIOTHORACIC SURGERY
Entity Type:Organization
Organization Name:BAPTIST HEALTH CENTER PRINCETON CARDIOTHORACIC SURGERY
Other - Org Name:BBH SCN HEART AND THORACIC SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:VALETA
Authorized Official - Middle Name:D
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-715-5901
Mailing Address - Street 1:833 PRINCETON AVE SW
Mailing Address - Street 2:POB III; SUITE 200A
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35211-1323
Mailing Address - Country:US
Mailing Address - Phone:205-786-2776
Mailing Address - Fax:205-786-6227
Practice Address - Street 1:833 PRINCETON AVE SW
Practice Address - Street 2:POB III; SUITE 200A
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211-1323
Practice Address - Country:US
Practice Address - Phone:205-786-2776
Practice Address - Fax:205-786-6227
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAPTIST HEALTH CENTERS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-14
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL146843Medicaid
AL146843Medicaid