Provider Demographics
NPI:1295940674
Name:BALDWIN OB-GYN PC
Entity type:Organization
Organization Name:BALDWIN OB-GYN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:DELACY
Authorized Official - Last Name:CLOUSETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-424-1100
Mailing Address - Street 1:1506 N MCKENZIE STREET
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-2264
Mailing Address - Country:US
Mailing Address - Phone:251-424-1100
Mailing Address - Fax:251-424-1110
Practice Address - Street 1:1506 N MCKENZIE STREET
Practice Address - Street 2:SUITE 104
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-2264
Practice Address - Country:US
Practice Address - Phone:251-424-1100
Practice Address - Fax:251-424-1110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17877207VH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VH0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529922890Medicaid
AL529922890Medicaid