Provider Demographics
NPI:1851698310
Name:VINCENTIAN PHYSICIAN SERVICES LLC
Entity Type:Organization
Organization Name:VINCENTIAN PHYSICIAN SERVICES 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 1:1130 22ND ST S STE 1000
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-2881
Mailing Address - Country:US
Mailing Address - Phone:205-930-2346
Mailing Address - Fax:205-930-2158
Practice Address - Street 1:810 SAINT VINCENT'S DRIVE
Practice Address - Street 2:3RD FLOOR; PHYSICIAN DEVELOPMENT DEPT
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1601
Practice Address - Country:US
Practice Address - Phone:205-930-2346
Practice Address - Fax:205-930-2158
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VINCENTIAN VENTURES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-18
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center