Provider Demographics
NPI:1528071776
Name:BAY MINETTE MEDICAL ARTS CENTER PC
Entity type:Organization
Organization Name:BAY MINETTE MEDICAL ARTS CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:SHERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-937-7970
Mailing Address - Street 1:1903 HAND AVE
Mailing Address - Street 2:
Mailing Address - City:BAY MINETTE
Mailing Address - State:AL
Mailing Address - Zip Code:36507
Mailing Address - Country:US
Mailing Address - Phone:251-937-7970
Mailing Address - Fax:251-937-9260
Practice Address - Street 1:1903 HAND AVE
Practice Address - Street 2:
Practice Address - City:BAY MINETTE
Practice Address - State:AL
Practice Address - Zip Code:36507
Practice Address - Country:US
Practice Address - Phone:251-937-7970
Practice Address - Fax:251-937-9260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
51029131OtherBLUE CROSS DR SHERMAN
12062OtherLICENSE DR SHERMAN
19994OtherLICENSE DR UDDIN
P00057539OtherRAILROAD MEDICARE NUMBER
00021976OtherLICENSE DR SPARKS
BU4967862OtherDEA DR UDDIN
AS2332865OtherDEA DR SHERMAN
00021976OtherLICENSE DR SPARKS
51029131OtherBLUE CROSS DR SHERMAN
=========OtherTAX ID DR SHERMAN
BS5954741OtherDEA DR SPARKS
51029131OtherBLUE CROSS DR SHERMAN