Provider Demographics
NPI:1780671495
Name:ST VINCENTS ST CLAIR LLC
Entity type:Organization
Organization Name:ST VINCENTS ST CLAIR LLC
Other - Org Name:<UNAVAIL>
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:205-814-2104
Mailing Address - Street 1:PO BOX 11407 LOCKBOX 1061
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-1061
Mailing Address - Country:US
Mailing Address - Phone:205-437-6098
Mailing Address - Fax:205-437-5998
Practice Address - Street 1:2805 DR JOHN HAYNES DR
Practice Address - Street 2:
Practice Address - City:PELL CITY
Practice Address - State:AL
Practice Address - Zip Code:35125-1448
Practice Address - Country:US
Practice Address - Phone:205-814-2104
Practice Address - Fax:205-814-2145
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST VINCENTS ST CLAIR LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-29
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALF856OtherBCBS GROUP PROVIDER #
AL311653OtherBLACK LUNG - DPT OF LABOR
AL529919640Medicaid
AL167885300OtherDEPT OF LABOR (OWCP)
AL3901720OtherUNITEDHEALTHCARE OF AL
ALF856OtherBCBS GROUP PROVIDER #
AL311653OtherBLACK LUNG - DPT OF LABOR