Provider Demographics
NPI:1891212494
Name:ST VINCENTS AMBULATORY HEALTHCARE NETWORK LLC
Entity Type:Organization
Organization Name:ST VINCENTS AMBULATORY HEALTHCARE NETWORK LLC
Other - Org Name:ST VINCENT'S ONE NINETEEN PHYSICAL THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:M
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-213-8705
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:205-212-6652
Mailing Address - Fax:
Practice Address - Street 1:7191 CAHABA VALLEY RD STE 102
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-6443
Practice Address - Country:US
Practice Address - Phone:205-408-6600
Practice Address - Fax:205-838-3216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-24
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy