Basic Information
| Provider Information | |||||||||
| NPI: | 1881098671 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST VINCENTS PINSON CLINIC LLC | ||||||||
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| OtherOrganizationName: | ST VINCENTS PINSON CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2701 7TH AVE S | ||||||||
| Address2: | THE HAYMAKER BUILDING | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352333405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059397633 | ||||||||
| FaxNumber: | 2059302158 | ||||||||
| Practice Location | |||||||||
| Address1: | 4360 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | PINSON | ||||||||
| State: | AL | ||||||||
| PostalCode: | 351263290 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2056804836 | ||||||||
| FaxNumber: | 2056802235 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2014 | ||||||||
| LastUpdateDate: | 09/06/2017 | ||||||||
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| AuthorizedOfficialLastName: | WILLIAMS | ||||||||
| AuthorizedOfficialFirstName: | BRANDON | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 2059397000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.