Provider Demographics
NPI:1790714459
Name:BALDWIN BONE & JOINT P C
Entity Type:Organization
Organization Name:BALDWIN BONE & JOINT P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLURG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-625-2663
Mailing Address - Street 1:1505 DAPHNE AVE
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-4298
Mailing Address - Country:US
Mailing Address - Phone:251-625-2663
Mailing Address - Fax:
Practice Address - Street 1:1505 DAPHNE AVE
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-4298
Practice Address - Country:US
Practice Address - Phone:251-625-2663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529910880Medicaid
AL4426490001Medicare NSC
ALI-742Medicare PIN