Provider Demographics
NPI:1366817199
Name:STV CARDIOLOGY CLINIC LLC
Entity Type:Organization
Organization Name:STV CARDIOLOGY CLINIC LLC
Other - Org Name:
Other - Org Type:
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:205-838-3766
Mailing Address - Street 1:50 MEDICAL PARK EAST DRIVE
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-3401
Mailing Address - Country:US
Mailing Address - Phone:205-930-2903
Mailing Address - Fax:205-930-2158
Practice Address - Street 1:46 MEDICAL PARK EAST DRIVE
Practice Address - Street 2:BUILDING 46, SUITE 460
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-3401
Practice Address - Country:US
Practice Address - Phone:205-930-2903
Practice Address - Fax:205-930-2158
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VINCENTIAN VENTURES OF NORTH ALABAMA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-04
Last Update Date:2017-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty