Healthcare Provider Details

I. General information

NPI: 1851690069
Provider Name (Legal Business Name): LIFELINE VASCULAR BIRMINGHAM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2011
Last Update Date: 03/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 LONDON PKWY SUITE 500
BIRMINGHAM AL
35211-6304
US

IV. Provider business mailing address

3 HAWTHORN PKWY SUITE 410
VERNON HILLS IL
60061-1446
US

V. Phone/Fax

Practice location:
  • Phone: 205-942-9896
  • Fax: 205-942-9948
Mailing address:
  • Phone: 847-388-2001
  • Fax: 847-388-2020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES HILGER
Title or Position: VP CONTROLLER
Credential:
Phone: 253-280-9501