Healthcare Provider Details

I. General information

NPI: 1740458967
Provider Name (Legal Business Name): EVI PHYSICIAN SERVICES I, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 08/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 GILBREATH DR
ONEONTA AL
35121-2827
US

IV. Provider business mailing address

810 SAINT VINCENTS DR
BIRMINGHAM AL
35205-1601
US

V. Phone/Fax

Practice location:
  • Phone: 205-274-3010
  • Fax: 205-274-3002
Mailing address:
  • Phone: 205-989-4833
  • Fax: 205-838-3102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. SUSAN CORNEJO
Title or Position: CORPORATE CONTROLLER
Credential:
Phone: 205-838-3718