Provider Demographics
NPI:1821173485
Name:BALDWIN COUNTY PRIMARY CARE, LLC
Entity Type:Organization
Organization Name:BALDWIN COUNTY PRIMARY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:R
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-943-5689
Mailing Address - Street 1:619 E LAUREL AVENUE
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-3301
Mailing Address - Country:US
Mailing Address - Phone:251-943-5689
Mailing Address - Fax:251-943-1041
Practice Address - Street 1:619 E LAUREL AVE
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-3301
Practice Address - Country:US
Practice Address - Phone:251-943-5689
Practice Address - Fax:251-943-1041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529916470Medicaid
AL=========OtherEIN
AL529916470Medicaid