Provider Demographics
NPI:1780648881
Name:BHC - HUEYTOWN
Entity Type:Organization
Organization Name:BHC - HUEYTOWN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF INTEGRATION OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:G.
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:FENN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-715-5415
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:205-715-5904
Mailing Address - Fax:205-715-5928
Practice Address - Street 1:2800 ALLISON BONNETT MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:HUEYTOWN
Practice Address - State:AL
Practice Address - Zip Code:35023-1845
Practice Address - Country:US
Practice Address - Phone:205-744-4410
Practice Address - Fax:205-744-6150
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAPTIST HEALTH CENTERS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-14
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529402430Medicaid
AL529402430Medicaid