1588988851 NPI number — VASCULAR INSTITUTE OF BIRMINGHAM, PC

Table of content: (NPI 1588988851)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588988851 NPI number — VASCULAR INSTITUTE OF BIRMINGHAM, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VASCULAR INSTITUTE OF BIRMINGHAM, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588988851
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 661495
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35266-1495
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-979-5882
Provider Business Mailing Address Fax Number:
205-979-1248

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2660 10TH AVE S
Provider Second Line Business Practice Location Address:
POB #1, SUITE 608
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35205-1605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-939-3495
Provider Business Practice Location Address Fax Number:
205-918-0147
Provider Enumeration Date:
03/16/2010

Additional Information

Authorized Official

Authorized Official Last Name:
WHITLEY
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
205-939-3495

Provider Taxonomy Codes

  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1588988851 . This is a "TRICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 118563 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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