Basic Information
| Provider Information | |||||||||
| NPI: | 1477912996 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STVBHM CARDIOLOGY CLINIC LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 PILOT MEDICAL DR STE 300 | ||||||||
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| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352353412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2058562284 | ||||||||
| FaxNumber: | 2058154777 | ||||||||
| Practice Location | |||||||||
| Address1: | 810 SAINT VINCENTS DR | ||||||||
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| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352051601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059397000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2016 | ||||||||
| LastUpdateDate: | 02/19/2019 | ||||||||
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| AuthorizedOfficialLastName: | WILLIAMS | ||||||||
| AuthorizedOfficialFirstName: | BRANDON | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 2058383766 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | VINCENTIAN VENTURES OF NORTH ALABAMA INC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0001X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology | 207RC0000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.