Provider Demographics
NPI:1669534947
Name:BHC-HOOVER FAMILY HEALTHCARE, INC.
Entity type:Organization
Organization Name:BHC-HOOVER FAMILY HEALTHCARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:G.
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:FENN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-715-5415
Mailing Address - Street 1:PO BOX 830605
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35283-0605
Mailing Address - Country:US
Mailing Address - Phone:205-715-5943
Mailing Address - Fax:205-715-5932
Practice Address - Street 1:5295 PRESERVE PKWY
Practice Address - Street 2:SUITE 210
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-4701
Practice Address - Country:US
Practice Address - Phone:205-682-6077
Practice Address - Fax:205-682-7746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL27614207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529930740Medicaid
ALL042Medicare PIN