Provider Demographics
NPI:1851799597
Name:BAPTIST MEDICAL CENTER SOUTH OB/GYN GROUP
Entity Type:Organization
Organization Name:BAPTIST MEDICAL CENTER SOUTH OB/GYN GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROOSEVELT
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCORVEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-262-0256
Mailing Address - Street 1:2601 WOODLEY PARD DRIVE
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116
Mailing Address - Country:US
Mailing Address - Phone:334-288-3400
Mailing Address - Fax:334-288-0188
Practice Address - Street 1:29 L V STABLER DR STE 4
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:AL
Practice Address - Zip Code:36037-3850
Practice Address - Country:US
Practice Address - Phone:334-288-3400
Practice Address - Fax:334-288-0188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-11
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty