Provider Demographics
NPI:1053445882
Name:ST. VINCENT'S ST. CLAIR, LLC
Entity Type:Organization
Organization Name:ST. VINCENT'S ST. CLAIR, LLC
Other - Org Name:ST. VINCENT'S ST. CLAIR CRNA'S
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-838-3718
Mailing Address - Street 1:2805 DR JOHN HAYNES DR
Mailing Address - Street 2:
Mailing Address - City:PELL CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35125-1448
Mailing Address - Country:US
Mailing Address - Phone:205-814-2104
Mailing Address - Fax:
Practice Address - Street 1:2805 DR JOHN HAYNES DR
Practice Address - Street 2:
Practice Address - City:PELL CITY
Practice Address - State:AL
Practice Address - Zip Code:35125-1448
Practice Address - Country:US
Practice Address - Phone:205-814-2104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. VINCENT'S ST. CLAIR, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-15
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529800500Medicaid
F208Medicare PIN
ALF208Medicare ID - Type UnspecifiedCRNA BILLING GRP NO