Provider Demographics
NPI:1861795387
Name:ST. VINCENT'S FAMILY CARE - BLOUNTSVILLE, LLC
Entity type:Organization
Organization Name:ST. VINCENT'S FAMILY CARE - BLOUNTSVILLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-274-3001
Mailing Address - Street 1:68278 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLOUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35031-3370
Mailing Address - Country:US
Mailing Address - Phone:205-429-0051
Mailing Address - Fax:
Practice Address - Street 1:68278 MAIN ST
Practice Address - Street 2:
Practice Address - City:BLOUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35031-3370
Practice Address - Country:US
Practice Address - Phone:205-429-0051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSAL HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care