Provider Demographics
NPI:1821031824
Name:BAPTIST HEALTH SYSTEM, INC.
Entity Type:Organization
Organization Name:BAPTIST HEALTH SYSTEM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF MEDICAL EDUCATION
Authorized Official - Prefix:
Authorized Official - First Name:STAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BREAUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-599-4823
Mailing Address - Street 1:2000 CRESTWOOD BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:IRONDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35210-2097
Mailing Address - Country:US
Mailing Address - Phone:205-592-5135
Mailing Address - Fax:205-592-1795
Practice Address - Street 1:2000 CRESTWOOD BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:IRONDALE
Practice Address - State:AL
Practice Address - Zip Code:35210-2097
Practice Address - Country:US
Practice Address - Phone:205-592-5135
Practice Address - Fax:205-592-1795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529501920Medicaid
ALE683Medicare PIN
AL529501920Medicaid