Provider Demographics
NPI:1336196856
Name:BREWTON MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:BREWTON MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:251-867-6071
Mailing Address - Street 1:PO BOX 648
Mailing Address - Street 2:
Mailing Address - City:BREWTON
Mailing Address - State:AL
Mailing Address - Zip Code:36427-0648
Mailing Address - Country:US
Mailing Address - Phone:251-867-6071
Mailing Address - Fax:251-867-5999
Practice Address - Street 1:1121 BELLEVILLE AVE
Practice Address - Street 2:
Practice Address - City:BREWTON
Practice Address - State:AL
Practice Address - Zip Code:36426-1505
Practice Address - Country:US
Practice Address - Phone:251-867-6071
Practice Address - Fax:251-867-5999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-29
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000060008Medicaid
ALCB0244OtherMEDICARE/RAILROAD MEDICAR
ALC008Medicare ID - Type Unspecified