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General NPI Number Information
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NPI Number | 1780671495
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Entity Type | Organization
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Legal Business Name | ST VINCENTS ST CLAIR LLC
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Dates
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Enumeration Date | 09/29/2005
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Last Update Date | 09/06/2017
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Provider Practice Location Address
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Address Line | 2805 DR JOHN HAYNES DR
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City | PELL CITY
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State | AL
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Zip | 35125-1448
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Country | US
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Telephone | 205-814-2104
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Fax | 205-814-2145
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Provider Business Mailing Address
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Address Line | PO BOX 11407 LOCKBOX 1061
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City | BIRMINGHAM
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State | AL
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Zip | 35246-1061
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Country | US
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Telephone | 205-437-6098
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Fax | 205-437-5998
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Authorized Official
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Title or Position | CFO
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Name | BRANDON WILLIAMS
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Credential |
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Telephone | 205-814-2104
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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