Provider Demographics
NPI:1205361912
Name:ST VINCENTS PRIMARY CARE PATCHWORK FARMS LLC
Entity type:Organization
Organization Name:ST VINCENTS PRIMARY CARE PATCHWORK FARMS 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:205-930-2456
Mailing Address - Street 1:3056 HEALTHY WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-2434
Mailing Address - Country:US
Mailing Address - Phone:205-995-9909
Mailing Address - Fax:205-930-2063
Practice Address - Street 1:3056 HEALTHY WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-2434
Practice Address - Country:US
Practice Address - Phone:205-995-9909
Practice Address - Fax:205-930-2063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-01
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty