Provider Demographics
NPI:1881995520
Name:ST. VINCENT'S CARDIOLOGY BLOUNT LLC
Entity type:Organization
Organization Name:ST. VINCENT'S CARDIOLOGY BLOUNT 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:205-274-3004
Mailing Address - Street 1:2700 10TH AVE S
Mailing Address - Street 2:SUITE 305
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1200
Mailing Address - Country:US
Mailing Address - Phone:205-939-0139
Mailing Address - Fax:
Practice Address - Street 1:150 GILBREATH DR
Practice Address - Street 2:SUITE B-100
Practice Address - City:ONEONTA
Practice Address - State:AL
Practice Address - Zip Code:35121-2827
Practice Address - Country:US
Practice Address - Phone:205-274-3353
Practice Address - Fax:205-274-3354
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSAL HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-11
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO-34207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL=========OtherEIN