Provider Demographics
NPI:1720524689
Name:COOSA VALLEY - ARISTO ER, LLC
Entity Type:Organization
Organization Name:COOSA VALLEY - ARISTO ER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:RICH
Authorized Official - Last Name:STREET
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:205-313-5202
Mailing Address - Street 1:PO BOX 830525
Mailing Address - Street 2:DEPT SF69
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35283-0525
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:315 W HICKORY ST
Practice Address - Street 2:
Practice Address - City:SYLACAUGA
Practice Address - State:AL
Practice Address - Zip Code:35150-2913
Practice Address - Country:US
Practice Address - Phone:256-401-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARISTO ER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-16
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty