Healthcare Provider Details

I. General information

NPI: 1518570068
Provider Name (Legal Business Name): LEG HEALTH VASCULAR CENTERS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2020
Last Update Date: 12/14/2021
Certification Date: 12/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2375 CHAMPIONS BLVD STE 100
AUBURN AL
36830-6471
US

IV. Provider business mailing address

2375 CHAMPIONS BLVD STE 100
AUBURN AL
36830-6471
US

V. Phone/Fax

Practice location:
  • Phone: 334-321-3700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JEFF WELCH
Title or Position: AO
Credential:
Phone: 205-563-5082