Provider Demographics
NPI:1598711616
Name:BAPTIST HEALTH SYSTEM, INC.
Entity Type:Organization
Organization Name:BAPTIST HEALTH SYSTEM, INC.
Other - Org Name:MEDICAL EDUCATION FACULTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR OF MEDICAL ED.
Authorized Official - Prefix:
Authorized Official - First Name:STAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BREAUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-599-4823
Mailing Address - Street 1:3686 GRANDVIEW PKWY
Mailing Address - Street 2:SUITE 810
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-3407
Mailing Address - Country:US
Mailing Address - Phone:205-971-5135
Mailing Address - Fax:205-971-5694
Practice Address - Street 1:3686 GRANDVIEW PKWY
Practice Address - Street 2:SUITE 810
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-3407
Practice Address - Country:US
Practice Address - Phone:205-971-5135
Practice Address - Fax:205-971-5694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529402710Medicaid
AL529402710Medicaid