Basic Information
Provider Information | |||||||||
NPI: | 1881048403 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | STV NEURO I LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
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Mailing Information | |||||||||
Address1: | 50 MEDICAL PARK DR E | ||||||||
Address2: | BLDG 46, STE 310, FINANCE | ||||||||
City: | BIRMINGHAM | ||||||||
State: | AL | ||||||||
PostalCode: | 352353401 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2058385286 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 806 SAINT VINCENTS DR | ||||||||
Address2: |   | ||||||||
City: | BIRMINGHAM | ||||||||
State: | AL | ||||||||
PostalCode: | 352051684 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2059865200 | ||||||||
FaxNumber: | 2059863250 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/20/2016 | ||||||||
LastUpdateDate: | 07/21/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | WILLIAMS | ||||||||
AuthorizedOfficialFirstName: | BRANDON | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CFO | ||||||||
AuthorizedOfficialTelephone: | 2058383766 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | VINCENTIAN VENTURES OF NORTH ALABAMA | ||||||||
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NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery |   |
No ID Information.