Provider Demographics
NPI:1528887551
Name:VISTA MEDICAL OF ALABAMA, INC
Entity type:Organization
Organization Name:VISTA MEDICAL OF ALABAMA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:KNAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-241-0905
Mailing Address - Street 1:1359 SPRING HILL AVE
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36604-3210
Mailing Address - Country:US
Mailing Address - Phone:251-241-0905
Mailing Address - Fax:251-800-7150
Practice Address - Street 1:1359 SPRING HILL AVE
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-3210
Practice Address - Country:US
Practice Address - Phone:251-241-0905
Practice Address - Fax:251-800-7150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Single Specialty