Provider Demographics
NPI:1679795777
Name:SOUTH BALDWIN CHILDRENS CENTER PC
Entity Type:Organization
Organization Name:SOUTH BALDWIN CHILDRENS CENTER PC
Other - Org Name:SOUTH BALDWIN CHILDRENS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:R
Authorized Official - Last Name:REED
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:251-943-5437
Mailing Address - Street 1:106 W MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-1935
Mailing Address - Country:US
Mailing Address - Phone:251-943-5437
Mailing Address - Fax:251-943-3227
Practice Address - Street 1:106 W MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-1935
Practice Address - Country:US
Practice Address - Phone:251-943-5437
Practice Address - Fax:251-943-3227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000013444Medicaid
AL630913928OtherEIN