Healthcare Provider Details

I. General information

NPI: 1578921581
Provider Name (Legal Business Name): STV SPORTS MEDICINE AND ORTHOPEDICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2016
Last Update Date: 09/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 SAINT VINCENTS DR SUITE 100
BIRMINGHAM AL
35205-1636
US

IV. Provider business mailing address

810 SAINT VINCENTS DR
BIRMINGHAM AL
35205-1601
US

V. Phone/Fax

Practice location:
  • Phone: 205-939-3699
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: BRANDON WILLIAMS
Title or Position: CFO
Credential:
Phone: 205-939-3699