Provider Demographics
NPI:1902832447
Name:VASCULAR SURGERY ASSOCIATES
Entity Type:Organization
Organization Name:VASCULAR SURGERY ASSOCIATES
Other - Org Name:SAME AS ABOVE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-536-9000
Mailing Address - Street 1:201 SIVLEY RD SW
Mailing Address - Street 2:STE 305
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5134
Mailing Address - Country:US
Mailing Address - Phone:256-536-9000
Mailing Address - Fax:256-265-6912
Practice Address - Street 1:201 SIVLEY RD SW
Practice Address - Street 2:SUITE 305
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801
Practice Address - Country:US
Practice Address - Phone:256-536-9000
Practice Address - Fax:256-265-6912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL094320305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALG73080OtherUPIN
ALH42548OtherUPIN
ALC70970OtherUPIN
ALH42548OtherUPIN
ALC70970OtherUPIN