Provider Demographics
NPI:1982121513
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 WELLNESS/DIETARY SERVICES
Other - Org Type:Other Name
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:205-838-3766
Mailing Address - Street 1:50 MEDICAL PARK DRIVE E BLDG 46
Mailing Address - Street 2:SUITE 310, FINANCE
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-3401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7191 CAHABA VALLEY RD STE 107
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-24
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty