Provider Demographics
NPI:1851694376
Name:ST. VINCENT'S MSO, LLC
Entity Type:Organization
Organization Name:ST. VINCENT'S MSO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SYSTEM DIRECTOR, PHYSICIAN DEVELOP.
Authorized Official - Prefix:MRS
Authorized Official - First Name:JONI
Authorized Official - Middle Name:
Authorized Official - Last Name:WYATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-930-2592
Mailing Address - Street 1:810 SAINT VINCENTS DR
Mailing Address - Street 2:ATTN: PHYSICIAN DEVELOPMENT / MSO
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1601
Mailing Address - Country:US
Mailing Address - Phone:205-930-2592
Mailing Address - Fax:205-930-2158
Practice Address - Street 1:810 SAINT VINCENTS DR
Practice Address - Street 2:ATTN: PHYSICIAN DEVELOPMENT / MSO
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1601
Practice Address - Country:US
Practice Address - Phone:205-930-2592
Practice Address - Fax:205-930-2158
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSAL HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty