Provider Demographics
NPI:1376266726
Name:BLUE LAKE HEALTH ALABAMA, LLC
Entity Type:Organization
Organization Name:BLUE LAKE HEALTH ALABAMA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:PATRICK
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:205-977-1949
Mailing Address - Street 1:3104 BLUE LAKE DR STE 110
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35243-2372
Mailing Address - Country:US
Mailing Address - Phone:205-977-1949
Mailing Address - Fax:205-977-1933
Practice Address - Street 1:103 HELTON CT
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-1464
Practice Address - Country:US
Practice Address - Phone:256-760-0672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty