Provider Demographics
NPI:1013283530
Name:IMC-NORTH BALDWIN PRIMARY PLUS, LLC
Entity Type:Organization
Organization Name:IMC-NORTH BALDWIN PRIMARY PLUS, LLC
Other - Org Name:NORTH BALDWIN PRIMARY PLUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:PALAZZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-435-1331
Mailing Address - Street 1:2115 HAND AVE
Mailing Address - Street 2:
Mailing Address - City:BAY MINETTE
Mailing Address - State:AL
Mailing Address - Zip Code:36507-4149
Mailing Address - Country:US
Mailing Address - Phone:251-937-7100
Mailing Address - Fax:
Practice Address - Street 1:2115 HAND AVE STE B
Practice Address - Street 2:
Practice Address - City:BAY MINETTE
Practice Address - State:AL
Practice Address - Zip Code:36507-4149
Practice Address - Country:US
Practice Address - Phone:251-937-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-29
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL137896Medicaid
AL137896Medicaid