Provider Demographics
NPI:1295013696
Name:VASCULAR CENTER OF MOBILE, P.C.
Entity Type:Organization
Organization Name:VASCULAR CENTER OF MOBILE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:N
Authorized Official - Last Name:SEABROOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-445-0075
Mailing Address - Street 1:1151 DAUPHIN ST
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36604-2547
Mailing Address - Country:US
Mailing Address - Phone:251-455-0075
Mailing Address - Fax:251-445-0072
Practice Address - Street 1:1151 DAUPHIN ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604
Practice Address - Country:US
Practice Address - Phone:251-445-0075
Practice Address - Fax:251-445-0072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-02
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD191752086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL131068Medicaid
AL51118091OtherBLUE CROSS BLUE SHIELD OF ALABAMA
AL1912900283OtherGLENN E. ESSES, M.D. - INDIVIDUAL NPI
AL1912900283OtherGLENN E. ESSES, M.D. - INDIVIDUAL NPI