Provider Demographics
NPI:1851690069
Name:LIFELINE VASCULAR BIRMINGHAM, INC
Entity Type:Organization
Organization Name:LIFELINE VASCULAR BIRMINGHAM, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:HILGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-280-9501
Mailing Address - Street 1:3 HAWTHORN PKWY
Mailing Address - Street 2:SUITE 410
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1446
Mailing Address - Country:US
Mailing Address - Phone:847-388-2001
Mailing Address - Fax:847-388-2020
Practice Address - Street 1:201 LONDON PKWY
Practice Address - Street 2:SUITE 500
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211-6304
Practice Address - Country:US
Practice Address - Phone:205-942-9896
Practice Address - Fax:205-942-9948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty