Provider Demographics
NPI:1013115294
Name:BHC-MEDSTAT OF JASPER
Entity type:Organization
Organization Name:BHC-MEDSTAT OF JASPER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:PRINGLE
Authorized Official - Last Name:RAMSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-715-5901
Mailing Address - Street 1:200 BEACON PKWY W
Mailing Address - Street 2:SUITE 330
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-3102
Mailing Address - Country:US
Mailing Address - Phone:205-715-5910
Mailing Address - Fax:205-715-5928
Practice Address - Street 1:3400 HIGHWAY 78 E
Practice Address - Street 2:MEDICAL ARTS TOWER; SUITE 109
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-8907
Practice Address - Country:US
Practice Address - Phone:205-387-1891
Practice Address - Fax:205-387-8227
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAPTIST HEALTH CENTERS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-10
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALL274OtherMEDICARE GROUP