=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235263062
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ST. VINCENT'S BLOUNT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/15/2007
-----------------------------------------------------
Last Update Date | 02/20/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 150 GILBREATH DR
-----------------------------------------------------
City | ONEONTA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35121-2827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-274-3055
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 150 GILBREATH DR
-----------------------------------------------------
City | ONEONTA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35121-2827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-274-3055
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | SCOTT HUGHES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 205-939-7230
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------