Provider Demographics
NPI:1023549292
Name:O'GORMAN VEIN & VASCULAR
Entity type:Organization
Organization Name:O'GORMAN VEIN & VASCULAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:C
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:COORDINATOR
Authorized Official - Phone:251-414-5900
Mailing Address - Street 1:861 HILLCRET RD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36685-0819
Mailing Address - Country:US
Mailing Address - Phone:251-410-8346
Mailing Address - Fax:251-410-8347
Practice Address - Street 1:861 HILLCREST RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-3909
Practice Address - Country:US
Practice Address - Phone:251-410-8346
Practice Address - Fax:251-410-8347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13943174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000019747Medicare PIN