Basic Information
| Provider Information | |||||||||
| NPI: | 1932650645 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST. VINCENT'S BLOUNT | ||||||||
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| OtherOrganizationName: | ST. VINCENT'S BLOUNT PHYSICIANS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50 MEDICAL PARK DR E | ||||||||
| Address2: | SUITE 310, FINANCE | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352353401 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 150 GILBREATH DR | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | ONEONTA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 351212827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2052743010 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2016 | ||||||||
| LastUpdateDate: | 09/06/2017 | ||||||||
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| AuthorizedOfficialLastName: | WILLIAMS | ||||||||
| AuthorizedOfficialFirstName: | BRANDON | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 2058383766 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ST. VINCENT'S HEALTH SYSTEM | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.