Provider Demographics
NPI:1801282868
Name:VASCULAR ASSOCIATES OF SOUTH ALABAMA, LLC
Entity type:Organization
Organization Name:VASCULAR ASSOCIATES OF SOUTH ALABAMA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:RADOSZEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-300-6969
Mailing Address - Street 1:PO BOX 850849
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36685-0849
Mailing Address - Country:US
Mailing Address - Phone:251-343-5004
Mailing Address - Fax:251-343-0833
Practice Address - Street 1:1551 OLD SHELL RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-1354
Practice Address - Country:US
Practice Address - Phone:251-410-8272
Practice Address - Fax:251-410-8273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-07
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102G704092Medicare PIN