Basic Information
| Provider Information | |||||||||
| NPI: | 1982121513 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST VINCENTS AMBULATORY HEALTHCARE NETWORK LLC | ||||||||
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| OtherOrganizationName: | ST. VINCENT'S ONE NINETEEN WELLNESS/DIETARY SERVICES | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50 MEDICAL PARK DRIVE E BLDG 46 | ||||||||
| Address2: | SUITE 310, FINANCE | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352353401 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 7191 CAHABA VALLEY RD STE 107 | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352426443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2054086600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2017 | ||||||||
| LastUpdateDate: | 09/06/2017 | ||||||||
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| AuthorizedOfficialLastName: | WILLIAMS | ||||||||
| AuthorizedOfficialFirstName: | BRANDON | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 2058383766 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.