Healthcare Provider Details

I. General information

NPI: 1780671495
Provider Name (Legal Business Name): ST VINCENTS ST CLAIR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 09/06/2017
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 11407 LOCKBOX 1061
BIRMINGHAM AL
35246-1061
US

V. Phone/Fax

Practice location:
  • Phone: 205-814-2104
  • Fax: 205-814-2145
Mailing address:
  • Phone: 205-437-6098
  • Fax: 205-437-5998

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: BRANDON WILLIAMS
Title or Position: CFO
Credential:
Phone: 205-814-2104