Provider Demographics
NPI:1770674111
Name:THE HEALTH CARE AUTHORITY FOR BAPTIST HEALTH
Entity Type:Organization
Organization Name:THE HEALTH CARE AUTHORITY FOR BAPTIST HEALTH
Other - Org Name:BAPTIST MEDICAL CENTER SOUTH HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:KEEFER
Authorized Official - Last Name:BELT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-273-4447
Mailing Address - Street 1:301 INTERSTATE PARK DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36109-5408
Mailing Address - Country:US
Mailing Address - Phone:334-395-5100
Mailing Address - Fax:
Practice Address - Street 1:301 INTERSTATE PARK DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36109-5408
Practice Address - Country:US
Practice Address - Phone:334-395-5100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE HEALTH CARE AUTHORITY FOR BAPTIST HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-28
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
11321251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALBAP7037AMedicaid
AL510-41202OtherBLUE CROSS BLUE SHIELD
AL=========OtherFED TAX ID
AL=========OtherUNITED HEALTH CARE
ALBAP7037AMedicaid
AL=========OtherTRICARE
AL=========OtherOTHER COMMERCIAL INS
AL510-41202OtherBLUE CROSS BLUE SHIELD
AL=========OtherCHAMPUS