Provider Demographics
NPI:1932418860
Name:HENRY M BORN MD PC
Entity Type:Organization
Organization Name:HENRY M BORN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BORN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-492-0544
Mailing Address - Street 1:3871 OLD US HIGHWAY 278 E
Mailing Address - Street 2:
Mailing Address - City:HOKES BLUFF
Mailing Address - State:AL
Mailing Address - Zip Code:35903-7507
Mailing Address - Country:US
Mailing Address - Phone:256-492-0544
Mailing Address - Fax:256-492-0558
Practice Address - Street 1:3871 OLD US HIGHWAY 278 E
Practice Address - Street 2:
Practice Address - City:HOKES BLUFF
Practice Address - State:AL
Practice Address - Zip Code:35903-7507
Practice Address - Country:US
Practice Address - Phone:256-492-0544
Practice Address - Fax:256-492-0558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009953560Medicaid
AL51503789OtherBLUE CROSS AND BLUE SHIELD
000010990Medicare PIN
AL009953560Medicaid