1780613059 NPI number — TENNESSEE VALLEY VASCULAR CONSULTANTS PC

Table of content: (NPI 1780613059)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780613059 NPI number — TENNESSEE VALLEY VASCULAR CONSULTANTS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TENNESSEE VALLEY VASCULAR CONSULTANTS PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780613059
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
420 LOWELL DR SE
Provider Second Line Business Mailing Address:
SUITE 500
Provider Business Mailing Address City Name:
HUNTSVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35801-3754
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-265-7480
Provider Business Mailing Address Fax Number:
256-265-7481

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
420 LOWELL DR SE
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
HUNTSVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35801-3754
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-265-7480
Provider Business Practice Location Address Fax Number:
256-265-7481
Provider Enumeration Date:
06/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STUCKY
Authorized Official First Name:
FRED
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
256-265-7480

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X , with the licence number:  0008023 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2086S0129X , with the licence number: 00016783 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0129X , with the licence number: 00017567 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 51514735STU . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51514734JOH . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: P00000016 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051514735 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0005683727 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 051514734 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00000018 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051514736 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51514736LOW . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: P00000017 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 0004070317 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0005999121 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".




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