Basic Information
| Provider Information | |||||||||
| NPI: | 1013191972 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST. VINCENT'S BLOUNT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1000 | ||||||||
| Address2: | |||||||||
| City: | ONEONTA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 351210013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2052743001 | ||||||||
| FaxNumber: | 2052743002 | ||||||||
| Practice Location | |||||||||
| Address1: | 150 GILBREATH DR | ||||||||
| Address2: | |||||||||
| City: | ONEONTA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 351212827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2052743001 | ||||||||
| FaxNumber: | 2052743002 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2007 | ||||||||
| LastUpdateDate: | 12/27/2007 | ||||||||
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| AuthorizedOfficialLastName: | TINNEY | ||||||||
| AuthorizedOfficialFirstName: | SEAN | ||||||||
| AuthorizedOfficialMiddleName: | CAREY | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/COO | ||||||||
| AuthorizedOfficialTelephone: | 2052743001 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | H0501 | AL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.