| Name: | St. Vincent's P.E.T. Center, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 11 May 2004 (21 years ago) |
| Entity Number: | 000-451-422 |
| Register Number: | 000451422 |
| County: | Walker |
| Place of Formation: | Walker County |
| Principal Address: | JASPER, AL |
| Registered Office Street Address: | 406 MEDICAL CENTER DRJASPER, AL 35501 |
| Registered Office Street Address ZIP Code: | 35501 |
Activities
OWN/OPERATE A POSITRON EMISSION TOMOGRAPHY MACHINE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1457337073 | 2005-12-15 | 2019-11-21 | 406 MEDICAL CENTER DR., JASPER, AL, 355013400, US | 2728 10TH AVE. S, STE. 300, BIRMINGHAM, AL, 352051202, US | |||||||||||||||||||||||||
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| Phone | +1 205-221-8200 |
| Fax | 2052218270 |
| Phone | +1 205-930-2670 |
| Fax | 2059302671 |
Authorized person
| Name | LISA J. WELLS |
| Role | EXECUTIVE DIRECTOR |
| Phone | 2052218258 |
Taxonomy
| Taxonomy Code | 2085R0202X - Diagnostic Radiology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 051555054 |
| State | AL |
| Name | Role |
|---|---|
| MERRICK, WILLIAM C | Agent |
| Name | Role |
|---|---|
| ST VINCENT'S HOSPITAL INC | Member |
| MED SOUTH INC | Member |
Date of last update: 13 Aug 2024
Sources: Alabama Secretary of State
