Provider Demographics
NPI:1659628543
Name:PAGE,HUDSON&TAYLOR GYNECOLOGY AT ST VINCENTS LLC
Entity Type:Organization
Organization Name:PAGE,HUDSON&TAYLOR GYNECOLOGY AT ST VINCENTS LLC
Other - Org Name:PAGE,HUDSON&TAYLOR GYNECOLOGY AT ST VINCENTS
Other - Org Type:Other Name
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:LENORA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-566-2906
Mailing Address - Street 1:806 SAINT VINCENTS DR
Mailing Address - Street 2:SUITE 430
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1684
Mailing Address - Country:US
Mailing Address - Phone:205-939-2806
Mailing Address - Fax:
Practice Address - Street 1:806 SAINT VINCENTS DR
Practice Address - Street 2:SUITE 430
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1684
Practice Address - Country:US
Practice Address - Phone:205-939-2806
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-09
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C74938Medicare UPIN
C74832Medicare UPIN
E41850Medicare UPIN