Provider Demographics
NPI:1902826118
Name:VASCULAR SPECIALISTS OF MOBILE, P.C.
Entity Type:Organization
Organization Name:VASCULAR SPECIALISTS OF MOBILE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEON
Authorized Official - Middle Name:
Authorized Official - Last Name:LARTIGUE
Authorized Official - Suffix:
Authorized Official - Credentials:CMM, CPC
Authorized Official - Phone:251-432-0558
Mailing Address - Street 1:171 MOBILE INFIRMARY BLVD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36607-3509
Mailing Address - Country:US
Mailing Address - Phone:251-432-0558
Mailing Address - Fax:251-432-0554
Practice Address - Street 1:171 MOBILE INFIRMARY BLVD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607-3509
Practice Address - Country:US
Practice Address - Phone:251-432-0558
Practice Address - Fax:251-432-0554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2086S0129X170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical GeneticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALS75619Medicare UPIN
ALGO6876Medicare UPIN
AL30017Medicare ID - Type UnspecifiedGLENN E. ESSES, M.D.
AL35232Medicare ID - Type UnspecifiedBENJAMIN P. WATTS, P.A.
AL30016Medicare ID - Type UnspecifiedRALPH B. PFEIFFER, JR., M
ALA26197Medicare UPIN