Provider Demographics
NPI:1154639227
Name:GENERAL AND VASCULAR SURGERY OF NORTHWEST ALABMA, INC.
Entity Type:Organization
Organization Name:GENERAL AND VASCULAR SURGERY OF NORTHWEST ALABMA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:MANORD
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:256-332-1500
Mailing Address - Street 1:PO BOX 660
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35653-0616
Mailing Address - Country:US
Mailing Address - Phone:256-332-1500
Mailing Address - Fax:256-398-8888
Practice Address - Street 1:15225 HIGHWAY 43 STE D
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AL
Practice Address - Zip Code:35653-1969
Practice Address - Country:US
Practice Address - Phone:256-332-1500
Practice Address - Fax:256-398-8888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL234362086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL126776Medicaid
511-17526OtherBCBS
AL126776Medicaid