Healthcare Provider Details

I. General information

NPI: 1619112141
Provider Name (Legal Business Name): ST. CLAIR EMERGENCY PHYSICIANS, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2008
Last Update Date: 12/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2805 DR JOHN HAYNES DR
PELL CITY AL
35125-1448
US

IV. Provider business mailing address

PO BOX 2244 MSC # 114
BIRMINGHAM AL
35201-2244
US

V. Phone/Fax

Practice location:
  • Phone: 205-338-3301
  • Fax: 205-313-5245
Mailing address:
  • Phone: 205-338-3301
  • Fax: 205-313-5245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BRYAN L BALENTINE
Title or Position: PRESIDENT
Credential: MD
Phone: 205-338-3301