Provider Demographics
NPI:1396415469
Name:BAY MINETTE HEALTH AND WELLNESS LLC
Entity Type:Organization
Organization Name:BAY MINETTE HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:OVERSTREET
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:251-401-4521
Mailing Address - Street 1:PO BOX 1807
Mailing Address - Street 2:
Mailing Address - City:BAY MINETTE
Mailing Address - State:AL
Mailing Address - Zip Code:36507-1807
Mailing Address - Country:US
Mailing Address - Phone:251-401-4521
Mailing Address - Fax:
Practice Address - Street 1:2012 HAND AVE
Practice Address - Street 2:
Practice Address - City:BAY MINETTE
Practice Address - State:AL
Practice Address - Zip Code:36507-4115
Practice Address - Country:US
Practice Address - Phone:251-401-4521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-20
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center