Provider Demographics
NPI:1841453644
Name:CITIZENS BAPTIST MEDICAL CENTER
Entity type:Organization
Organization Name:CITIZENS BAPTIST MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MILDRED
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:CLINE
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:256-487-1946
Mailing Address - Street 1:604 STONE AVE
Mailing Address - Street 2:
Mailing Address - City:TALLADEGA
Mailing Address - State:AL
Mailing Address - Zip Code:35160-2217
Mailing Address - Country:US
Mailing Address - Phone:256-761-4363
Mailing Address - Fax:263-761-4367
Practice Address - Street 1:604 STONE AVE
Practice Address - Street 2:
Practice Address - City:TALLADEGA
Practice Address - State:AL
Practice Address - Zip Code:35160-2217
Practice Address - Country:US
Practice Address - Phone:256-761-4363
Practice Address - Fax:263-761-4367
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOME HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL017156282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural