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General NPI Number Information
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NPI Number | 1528887551
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Entity Type | Organization
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Legal Business Name | VISTA MEDICAL OF ALABAMA, INC
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Dates
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Enumeration Date | 10/07/2024
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | 1359 SPRING HILL AVE
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City | MOBILE
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State | AL
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Zip | 36604-3210
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Country | US
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Telephone | 251-241-0905
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Fax | 251-800-7150
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Provider Business Mailing Address
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Address Line | 1359 SPRING HILL AVE
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City | MOBILE
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State | AL
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Zip | 36604-3210
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Country | US
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Telephone | 251-241-0905
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Fax | 251-800-7150
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JOEL W KNAIN
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Credential |
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Telephone | 251-241-0905
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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