Provider Demographics
NPI:1629166194
Name:CITIZENS BAPTIST MEDICAL CENTER
Entity Type:Organization
Organization Name:CITIZENS BAPTIST MEDICAL CENTER
Other - Org Name:CITIZENS BAPTIST MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-761-4490
Mailing Address - Street 1:PO BOX 830605
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35283-0605
Mailing Address - Country:US
Mailing Address - Phone:205-715-5427
Mailing Address - Fax:205-715-5878
Practice Address - Street 1:604 STONE AVE
Practice Address - Street 2:
Practice Address - City:TALLADEGA
Practice Address - State:AL
Practice Address - Zip Code:35160-2217
Practice Address - Country:US
Practice Address - Phone:256-362-8111
Practice Address - Fax:256-761-4543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALHOS0101HMedicaid
AL038OtherBLUE CROSS
AL01-0101Medicare Oscar/Certification
AL=========OtherCHAMPUS