Healthcare Provider Details

I. General information

NPI: 1477912996
Provider Name (Legal Business Name): STVBHM CARDIOLOGY CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2016
Last Update Date: 02/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 SAINT VINCENTS DR
BIRMINGHAM AL
35205-1601
US

IV. Provider business mailing address

100 PILOT MEDICAL DR STE 300
BIRMINGHAM AL
35235-3412
US

V. Phone/Fax

Practice location:
  • Phone: 205-939-7000
  • Fax:
Mailing address:
  • Phone: 205-856-2284
  • Fax: 205-815-4777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State

VIII. Authorized Official

Name: BRANDON WILLIAMS
Title or Position: CFO
Credential:
Phone: 205-838-3766