Healthcare Provider Details

I. General information

NPI: 1467818575
Provider Name (Legal Business Name): STV SPORTS MEDICINE & ORTHOPEDICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2016
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

805 SAINT VINCENTS DR STE 100
BIRMINGHAM AL
35205-1638
US

V. Phone/Fax

Practice location:
  • Phone: 205-939-3699
  • Fax: 205-484-2585
Mailing address:
  • Phone: 205-939-3699
  • Fax: 205-484-2585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: LISA WARREN
Title or Position: CEO
Credential:
Phone: 205-939-3699