Bayouclinic, Inc.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

BAYOUCLINIC, INC.

Doing business as

Bayou La Batre Rural Health Clinic

Practice address

13833 Tapia Ave
Bayou la Batre, AL 36509-2515

Phone

(251) 824-4985

Fax

(251) 824-4990

NPI assigned

Mar 15, 2006

Last updated

Oct 14, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Julie H Taylor

Title

Interim Executive Director

Phone

(251) 824-4985

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Bayou La Batre Rural Health Clinic Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1142380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665705600000",
    "number": "1114996865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13220 N WINTZELL AVE",
            "city": "BAYOU LA BATRE",
            "state": "AL",
            "postal_code": "365092142",
            "telephone_number": "251-824-4985",
            "fax_number": "251-824-4990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13833 TAPIA AVE",
            "city": "BAYOU LA BATRE",
            "state": "AL",
            "postal_code": "365092515",
            "telephone_number": "251-824-4985",
            "fax_number": "251-824-4990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAYOUCLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-15",
        "last_updated": "2022-10-14",
        "certification_date": "2022-10-14",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "JULIE",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "INTERIM EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "251-824-4985"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "AL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "529932897",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "541003845",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bayou La Batre Rural Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bayou La Batre Rural Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Regina M Benjamin, MD
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• Karen J Faulk, MSW, LICSW

• Family Medicine Physician in Bayou la Batre, AL
• Providers in Bayou la Batre, AL by specialty
• Family Medicine Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.