Provider Demographics
NPI:1962871178
Name:ST VINCENT'S INTERNAL MEDICINE MAYFAIR LLC
Entity type:Organization
Organization Name:ST VINCENT'S INTERNAL MEDICINE MAYFAIR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-838-3766
Mailing Address - Street 1:50 MEDICAL PARK EAST DRIVE
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-3401
Mailing Address - Country:US
Mailing Address - Phone:205-871-7007
Mailing Address - Fax:205-871-9449
Practice Address - Street 1:3106 INDEPENDENCE DRIVE
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-4112
Practice Address - Country:US
Practice Address - Phone:205-871-7007
Practice Address - Fax:205-871-9449
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VINCENTIAN VENTURES OF NORTH ALABAMA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-17
Last Update Date:2017-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty