Provider Demographics
NPI:1295850287
Name:ALABAMA HEALTH SERVICES ST CLAIR LLC
Entity Type:Organization
Organization Name:ALABAMA HEALTH SERVICES ST CLAIR LLC
Other - Org Name:ALABAMA HEALTH SERVICES ST CLAIR ANESTHESIA
Other - Org Type:Doing Business As
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:205-838-3426
Mailing Address - Street 1:PO BOX 2726
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35202-2726
Mailing Address - Country:US
Mailing Address - Phone:205-322-1808
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:205-338-3301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALABAMA HEALTH SERVICES ST CLAIR LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-20
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529800500Medicaid
ALF208Medicare PIN