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NPI Code Detail

MEDICARE: ST. CLAIR EMERGENCY PHYSICIANS, LLC.

MEDICARE: ST. CLAIR EMERGENCY PHYSICIANS, LLC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician

General Provider Information

NPI Number : 1619112141
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST. CLAIR EMERGENCY PHYSICIANS, LLC.
Provider Business Mailing Address
First Line : PO BOX 2244
Second Line : MSC # 114
City : BIRMINGHAM
State : AL
Zip : 35201-2244
Country : US
Telephone Number : 205-338-3301
Fax Number : 205-313-5245
Provider Business Practice Location Address
First Line : 2805 DR JOHN HAYNES DR
Second Line :
City : PELL CITY
State : AL
Zip : 35125-1448
Country : US
Telephone Number : 205-338-3301
Fax Number : 205-313-5245
Authorized Official
Title or Position : PRESIDENT
Name : BRYAN L BALENTINE
Credential : MD
Telephone Number : 205-338-3301
Provider Enumeration Date : 12/12/2008
Last Update Date : 12/12/2008

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Directions to “ST. CLAIR EMERGENCY PHYSICIANS, LLC. ” Practice Location

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