Provider Demographics
NPI:1225059165
Name:MONTGOMERY VASCULAR SURGERY, P.C.
Entity Type:Organization
Organization Name:MONTGOMERY VASCULAR SURGERY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:ENGLES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-284-6500
Mailing Address - Street 1:2055 E SOUTH BLVD STE 503
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-2004
Mailing Address - Country:US
Mailing Address - Phone:334-284-6500
Mailing Address - Fax:334-284-6202
Practice Address - Street 1:2055 E SOUTH BLVD STE 503
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-2004
Practice Address - Country:US
Practice Address - Phone:334-284-6500
Practice Address - Fax:334-284-6202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL378174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL=========OtherTAX ID NUMBER
AL6481320001Medicare NSC